Employment

Application
Date __________

Personal Information

Last Name _______________ First Name _______________ MI _______________

Mailing Address ________________________________________________________________

City_______________ State _______________ Zip _______________

Telephone _______________ (Cell-phone) _______________ E-mail ____________________

Employment Related Information

Can you show proof that you are legally able to work in the US? Yes ( ) No ( )

Are you at least 18 years of age? Yes ( ) No ( )

Have you ever been convicted of a crime, felony or misdemeanor? Yes ( ) No ( )

If yes, please fully describe the circumstances: ________________________________________

______________________________________________________________________________

What is the job position you are applying for? ________________________________________

Wage expectancy _______________

What date are you available to start work? _______________

Social Security Number: _______________

Type of job are you seeking: Full Time ( ) Part Time ( ) Temporary ( ) Seasonal ( )

If you are interested in seasonal/temporary work, what is your availability? ________________

Days available to work: Mon ( ) Tues ( ) Wed ( ) Thurs ( ) Fri ( ) Sat ( ) Sun ( )

Please note any times that you are unavailable to work: ________________________________
Employment History

Are you currently employed? Yes ( ) No ( )

(If yes) May we contact your employer? Yes ( ) No ( )

Please list your employment history starting with your present or most recent employer.

Company/Employer _______________ Phone number ______________ City______________

Employment dates: From __________ To __________ Position title ________________

Duties and responsibilities: _______________________________________________________

Supervisors name and title: _________________________ Salary upon departure: _________

Company/Employer _______________ Phone number ______________ City______________

Employment dates: From __________ To __________ Position title ________________

Duties and responsibilities: _______________________________________________________

Supervisors name and title: _________________________ Salary upon departure: _________

Company/Employer _______________ Phone number ______________ City______________

Employment dates: From __________ To __________ Position title ________________

Duties and responsibilities: _______________________________________________________

Supervisors name and title: _________________________ Salary upon departure: _________

In which of these companies did you learn the most? Why? _____________________________
______________________________________________________________________________
What do you like the most about working in restaurants? _______________________________
______________________________________________________________________________
What personal skills and qualifications will make you a unique asset to Cosmes team?

______________________________________________________________________________
Please note your short-term and long-term goals in the food & beverage or hospitality industry:
______________________________________________________________________________
______________________________________________________________________________
Please note any hobbies, activities, or other interests outside of the restaurant industry:

Education and Skills

Please list below the attended schools starting with present or most recent.

School: _______________ Address _______________________________________________

Type of Diploma/Degree: _______________ Did you graduate? Yes ( ) No ( )

Notes (special activities, honors, etc.): ______________________________________________

School: _______________ Address _______________________________________________

Type of Diploma/Degree: _______________ Did you graduate? Yes ( ) No ( )

Notes (special activities, honors, etc.): ______________________________________________

Do you currently or have you in the past served in the US military? Yes ( ) No ( )

Branch of service: ______________________ Dates: From _________ To _________

Duties: ________________________________________________________________________

Please note if you are fluent in a language other than English: ___________________________

Rate fluency from 1 to 10: ________________________________________________________

What type of computer experience do you have? _____________________________________

(Include word processing, Excel, POS systems, database, etc)

Personal References (No relatives please)

Name _______________ Occupation _______________ Phone number _______________

Address __________________________________ Years and context known _______________

Name _______________ Occupation _______________ Phone number _______________

Address__________________________________ Years and context known _______________

I have fully read the application and I certify that all the information provided in this application
is complete and truthful. I understand that if employed, any false statements or omissions will
be considered falsification of records and cause for dismissal. I authorize the investigation of
previous employment, personal history, and contact of provided references.

Signature ____________________ Date: ______________