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Fredericksburg
10040 Patriot Highway
Fredericksburg VA
540-898-8338
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Employment
Employment
Please fill in all the required fields
PERSONAL INFORMATION
Date of Application
*
First Name
*
Last Name
*
Email Address
*
Email Address Confirmed
*
Home Address
*
Apt./Unit #
City
*
State
*
Zip Code
*
Home Phone Number
*
Cell Phone Number
Can you submit proof of legal employment authorization and identity?
*
Yes
No
If you are under 18, can you furnish a work permit?
*
Yes
No
Have you ever been previously employed by our organization?
*
Yes
No
If yes, where?
*
If yes, when?
*
Have you ever been convicted of a felony in the last 7 years?
*
Yes
No
If yes, explain.
*
Select Location Desired
*
Choose a location
Huntsville Jordan Lane
Huntsville Memorial Pkwy
Madison
Jonesboro AR Alexander Drive
Jonesboro AR Parkwood Road
Owasso
Philadelphia PA Willits Road
Philadelphia Roxboro
West Chester
Nolensville Hillside Center
Greenville
Laredo
Fredericksburg
Select Position Desired
*
--Select a Position--
Server
Bartender
Hostess
Cook
Manager
Accounting
Marketing
Operations
Finance
HR
Delivery Driver
Counter Help
Other
Salary Desired
Are you currently employed?
*
Yes
No
If yes, may we contact your previous employer?
*
Yes
No
Select Availability
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Date Available
*
Referred By
Phone Number
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PREVIOUS EMPLOYMENT
PREVIOUS JOB #1
Company
Phone
Address
Supervisor
Position
Salary
Employed From
Employed To
Reason for leaving
PREVIOUS JOB #2
[+]
Company
Phone
Address
Supervisor
Position
Salary
Employed From
Employed To
Reason for leaving
PREVIOUS JOB #3
[+]
Company
Phone
Address
Supervisor
Position
Salary
Employed From
Employed To
Reason for leaving
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EDUCATION
High School
*
Address
From
*
To
*
Did you graduate?
*
Yes
No
Degree Earned
College
Address
From
To
Did you graduate?
Yes
No
Degree Earned
Technical/Trade
Address
From
To
Did you graduate?
Yes
No
Degree Earned
Other
Address
From
To
Did you graduate?
Yes
No
Degree Earned
Skills and Qualifications
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REFERENCES
REFERENCE #1
Full Name
*
Relationship
*
Years Known
*
Address
*
Phone
*
REFERENCE #2
Full Name
*
Relationship
*
Years Known
*
Address
*
Phone
*
REFERENCE #3
Full Name
*
Relationship
*
Years Known
*
Address
*
Phone
*
Upload
Signature Full Name
*
Signature Date
*
Signature Certify
*
Yes, I would like to receive Email Alerts
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