Brewer’s Alley - Application for Employment

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status.
** PLEASE PRINT CLEARLY **
Position(s) applied for  	  Date  	/	/	  	
How did you find out about this job?     q Newspaper  q Employee  q Walk-in   q Relative   q Other  	
Why are you seeking a new job at this time? 	
 Applicant Information						 
First Name  	  Middle  	  Last  		
Street Address  	  Social Security No.  	
City/State/Zip  	  Phone  (____) 	
If hired, do you have a reliable means of transportation to get to work?           Describe  	
Are you at least 18 years old? 	    If you are under 18 years of age, can you furnish a work permit? 	
If the job you are applying for requires driving: Driver’s License No.     	                 State  	  Expiration Date  	
Are you legally eligible for employment in the U.S.?       (Proof of U.S. citizenship or immigration status is required if hired.)
Have you been convicted of a crime? q Yes     q No     If yes, state the nature of the offense and disposition of the case. Include dates and places.  (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.)

Are you a veteran?            If yes, give dates of service:  From   	        To 	
List any special skills or training:  		

 Employment Information						 
Are you seeking full time, part time or temporary employment?      	                                        
What hours and shift(s) would you prefer to work? 	
List times you are not available to work?  	
Are you willing to work overtime?          Weekends?           Holidays?           .
Are you currently employed?           If hired, when would you be able to start?  	
Have you ever worked for this organization before?          If yes, name used:  	
List any friends or relatives employed by this company:  	
Have you ever been discharged or asked to resign from any position?                     If yes, please describe:  	
	
If applicable, please refer to the attached job description for the position for which you are applying.  Are you able to perform all these tasks with or without reasonable accommodation?             Please describe which tasks, if any, you will need accommodation to perform, and explain what type of accommodation you will need:  	

Please describe: 	

 Education (circle highest level achieved)						 

Elementary:         1   2   3   4   5   6   7   8        Secondary:   9   10   11   12   G.E.D     	College:   1   2   3   4   5   6   7   8
Name of School:  		Name of School:  		Name of School: 	 
Location of School:  		Location of School: 		Location of School:  	
If in high school, are you enrolled in a recognized co-op program?   Yes   No		Degree & Major:  	
If yes, identify program and school:  				Minor:  	

  Work History (please begin with most recent)						 

1.	Company  	  Phone No. with Area Code  (             )	
	Address  	  City/State/Zip  	
	Dates of Employment:  From  	  To  	  Salary:  Beginning  	  Ending  	
	Job Title  	  Supervisor’s Name & Title  	
	Describe duties briefly:  	
	Specific reason for leaving:  	
2.	Company  	  Phone No. with Area Code  (             )	
	Address  	  City/State/Zip  	
	Dates of Employment:  From  	  To  	  Salary:  Beginning  	  Ending  	
	Job Title  	  Supervisor’s Name & Title  	
	Describe duties briefly:  	
	Specific reason for leaving:  	
3.	Company  	  Phone No. with Area Code  (             )	
	Address  	  City/State/Zip  	
	Dates of Employment:  From  	  To  	  Salary:  Beginning  	  Ending  	
	Job Title  	  Supervisor’s Name & Title  	
	Describe duties briefly:  	
	Specific reason for leaving:  	
4.	Company  	  Phone No. with Area Code  (             )	
	Address  	  City/State/Zip  	
	Dates of Employment:  From  	  To  	  Salary:  Beginning  	  Ending  	
	Job Title  	  Supervisor’s Name & Title  	
	Describe duties briefly:  	
	Specific reason for leaving:  			
For references purposes: Have you worked for any of these organizations or attended school under a different name?                 .      If yes, give name and organization(s) 	
May we contact the employers listed above?         If not, list the employers you do not wish us to contact and why:

Applicant Signature:___________________________________________________Date:_______________