Buffalo Burger

Applicant information

Applicant name	:
Home phone	:
Other	:
Email address	:
Nationality	:
Place of birth	:
Do you own a car?	:	Yes No
Current address
Number and street	:
City	:
Country	:
How were you referred to the company?	:

Employment positions

Education, training and experience High school

School name	:
School address	:
School city, state, zip	:
Number of years completed	:
Did you graduate?	:	Yes No
Degree / diploma earned	:
College / university
School name	:
School address	:
School city, state, zip	:
Number of years completed	:
Did you graduate?	:	Yes No
Degree / diploma earned	:
Vocational School	:
Name	:
Address	:
City, state, zip	:
Number of years completed	:
Did you graduate?	:	Yes No
Degree / diploma?	:

Military

Branch	:
Rank in military	:
Total Years of Service	:
Skills/duties	:
Related details	:
Do you speak, write or understand any foreign languages?	:	Yes No
If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be	:
Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us?	:	Yes No
If yes, please explain	:

Employment history

References

List below three persons who have knowledge of your work performance within the last four years. Please include professional references only.
Name - first, last	:
Telephone number	:
Address	:
City, state, zip	:
Occupation	:
Number of years Acquainted	:

Name - first, last	:
Telephone number	:
Address	:
City, state, zip	:
Occupation	:
Number of years acquainted	:

Name - first, last	:
Telephone number	:
Address	:
City, state, zip	:
Occupation	:
Number of years acquainted	:

Please read and initial each paragraph, then sign below

I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.

I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.

I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.

Applicant's name	Date

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