Careers Applicant Name* Position Desired*ServerHostBartenderLine CookDishwasherAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Date Available to Start* MM slash DD slash YYYY How did you learn about the job opportunities with Dooley's? (E.G., window sign, referral from employee, classified ad, etc.) YOUR AVAILABILITYHours* Full Time (more than 30 hours/week) Part Time (less than 30 hours/week) AM Hours Available to WorkMonTuesWedThursFriSatSunPlease place an 'x' in the box if you are available during this time.PM Hours Available to WorkMonTuesWedThursFriSatSunPlease place an 'x' in the box if you are available during this time.Are you able to meet the attendance requirements?* yes no Can you submit proof of legal employment authorization and identity?* yes no Do you have any objection to working overtime if necessary?* yes no If you are under 18, can you furnish a work permit if it is required?* yes no Have you ever been convicted of a crime in the last 7 years?* yes no If yes, please explain below (a conviction will not automatically bar employment)Have you ever been previously employed by our organization?* yes no Explanation EMPLOYMENT HISTORYMost Recent EmploymentPrior EmploymentDates of Employment Dates of Employment Position Position Pay Rate Pay Rate Business Name Business Name AddressAddressPhonePhoneSupervisor Name Supervisor Name Reason for LeavingReason for LeavingOTHER SKILLS AND QUALIFICATIONSSummarize any job-related training, skills, licenses, certificates, and/or other qualifications taht may apply)Other Skills EDUCATION(List school name and location, years completed, course of study, and any degrees earned)High School College / University Technical Training REFERENCESList 3 references names, telephone numbers, and years known (not including relatives)References*I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.Name First Last By checking this box, I acknowledge my electronic signature Date MM slash DD slash YYYY
