Employment Be a valuable team member at Randy's Family Restaurant. Where Faith, Family, and Friends matter most! Personal Information First Name Last Name MI Phone Date of Birth Current Age Address Email Do You Have A Criminal Record? YesNo If Yes Explain? Did Someone Refer You? If So Who? Please Provide an Emergency Contact Name Phone Relationship Job Information Position Applying For Wait StaffHost/HostessCookDishwasherCleaner What is Your Desired Rate of Pay? Type of Employment Full TimePart TimeAny What Date Are You Available to Start Education Have You Graduated High School? YesNo Are You In College? YesNo Years Left? Employment History Is This Your First Job? YesNo Starting with your most recent employer, provide the following information. Employer Dates Employed: Job Title Phone May We Contact? YesNo Why Did You Leave This Job? Employer Dates Employed: Job Title Phone May We Contact? YesNo Why Did You Leave This Job? Employer Dates Employed: Job Title Phone May We Contact? YesNo Why Did You Leave This Job? Employer Dates Employed: Job Title Phone May We Contact? YesNo Why Did You Leave This Job? Other Information Have You Ever Been Fired From a Job? YesNo Have You Ever Worked in A Restaurant Before? YesNo Are You Currently Employed? YesNo Will Randy's Be Your Only Job? YesNo If No, Will Randy's Be Your Primary or Secondary Job? Why Do You Think Randy's Should Hire You? I certify that all information I have provided in order to apply for and secure work with the employer is true, complete, and correct. Yes I expressly authorize Randy’s Family Restaurant to contact and obtain information from all references (personal and professional) to otherwise verify the accuracy of all information provided by me in this application, résumé, or job interview. Yes Signature of Applicant Date Signed