Positions for which you are Applying:

(Bartendar, Barback, Security, Doorman)

Date Available to Start:

Desired Schedule:

FULL NAME:

PRESENT Address:

PRESENT City, State, Zip:

PREVIOUS Address:

PREVIOUS City, State, Zip:

E-Mail Address:

Day Phone
(with area code):

Evening Phone
(with area code):

Cell Phone:

Date of Birth:

Employment History
(include Employer, address, dates of employment, work performed, reason for leaving, and anything else you think we need to know):

Reference 1:

Reference 2:

Reference 3:

I hereby affirm that the information given by me on this application for employment is complete and accurate, I understand that any falsification will be immediate grounds for dismissal. I authorize a thorough investigation to be made in connection with this application concerning my character, general reputation, personal characteristics, employment, education background, and criminal record, whichever is applicable. I understand that this investigation may include personal interviews with third parties such as family members, business associates, financial sources, friends, neighbors, and others with whom I am acquainted.

It is my understanding that as a prerequisite to consideration for employment, I must agree to submit to any post-employment examinations, physical or other, as Q Corporation may lawfully require. The corporation will pay the reasonable cost of any such examination which may be required.

I understand and agree that any falsification or omission either on this form or in my response to questions asked during any interview or other examination process is grounds for immediate termination of my employment no matter when the falsification or omission is discovered.

If I am hired, I agree that my employment and compensation can be terminated with or without cause and without notice at any time, at the option of Q, Inc. or myself. I understand that no representative of Q, Inc. other than an owner has the authority to enter into an agreement for any specified period of time or to make any agreement contrary to the foregoing. I further understand that I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of the nature and scope of the investigation.

I have read and affirm as my own the above statements.