Moseberth’s Fried Chicken

Application for Employment

Please tell us about yourself

Last Name: / M.I.: / First Name: / Date:
Present Address: / City: / State: / Zip:
Home Phone: / Work Phone: / Cell Phone:
In case of emergency, please notify (Name): / Phone (H):
Address: / City: / State: / Zip:
Do you have reliable transportation to work?:
Yes No / What wage are you expecting?:
If younger than 18, how old are you?: / Have you ever been convicted of a felony?:
Yes No
Are you eligible to work in the U.S.?:
Yes No / Social Security #:

When are you available to work?

Summer: / School Year: / All Year:
Minimum # of hours needed to work: / Maximum # of hours needed to work:
Tuesday / Wednesday / Thursday / Friday / Saturday

From

To

Please list your 3 most recent jobs

Have you ever worked at Moseberth’s?:
Yes No / If yes, when?:
From: / To: / Name & Address of Employer: / Phone#: / Manager: / Wage: / Reason for leaving:

Education

High School: / Location: /

Did you graduate?

Yes No
College or Trade School: / Location: /

Did you graduate?

Yes No

Personal Background

What are your interest and activities?:
Please list awards or leadership positions held (work or school):

Military Service

Yes No / Branch: / Rank: / Start Date: / End Date:
Please describe your duties:

Personal References (No more than 2 family members)

Name: / Address: / Phone: / Relation: / Years Known:

**Please read and sign electronically on next page

I understand that completion of this application does not indicate that there are any positions currently open and does not obligate Moseberth’s Fried Chicken to hire me. I certify that all of the answers given in this application are true an complete to the best of my knowledge and are subject to confirmation by Moseberth’s Fried Chicken.

Moseberth’s Fried Chicken may make such investigations and inquiries of my personal, employment, financial, academic history and other related matters as my be necessary in determining whether I can perform the essential functions of the position which I seek. I hereby release past employers, schools, and all persons contacted from all liability in responding to inquiries in connection with my application.

If I am employed, I understand that false or misleading information given in my application or interview(s) may result in termination. I understand that I am required to abide by all employer rules and regulations.

*By typing in your full name and dating this application you are stating that you understand everything you read above. This will serve as your electronic signature.

Name: / Date: