Employment Application

Which restaurant(s) are you applying to work at with this application? *
 Rockfish Public House
 White Rose Bar & Grill
 White Rose At Bridgewater
Position(s) applied for: *
How did you hear about this job? *
 Newspaper
 Employee
 Walk-In
 Relative
 Other
Why are you seeking a new job at this time? *

Applicant Information

Name *
Address *
City/State/Zip *
Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West VirginiA Wisconsin Wyoming Phone *
If hired, do you have a reliable means of transportation to get to work? *
Please Select Yes No Describe
Are you at least 18 years old? *
Please Select Yes No If you are under 18 years of age, can you furnish a work permit? *
Please Select Yes No If the job you are applying for requires driving:
License No:
State:
Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West VirginiA Wisconsin Wyoming Expiration Date:
Are you legally eligible for employment in the U.S.? *
Please Select Yes No
(PROOF OF U.S. CITIZENSHIP OR IMMIGRATION STATUS IS REQUIRED IF HIRED.)
Have you been convicted of a crime? (Massachusetts applicants should not include misdemeanor convictions; California applicants should not include marijuana-related convictions that occurred more than 2 years prior to the application date.) *
Please Select Yes 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? *
Please Select Yes No If yes, dates of service:
From:

To:

Special skills or training:

Employment Information

Are you seeking full time, part time or temporary employment? *
Please Select Full Time Part Time Temporary What hours and shift(s) would you prefer to work? *
List times you are not available to work *
Are you willing to work overtime? *
Please Select Yes No Weekends? *
Please Select Yes No Holidays? *
Please Select Yes No Are you currently employed? *
Please Select Yes No If hired, when would you be able to start? *
Have you ever worked for this organization before? *
Please Select Yes No 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? *
Please Select Yes No 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 Select Yes No Please describe which tasks, if any, you will need accommodation to perform, and explain what type of accommodation you will need:

Education

(CHOOSE HIGHEST LEVEL ACHIEVED) Elementary *
Please Select One Two Three Four Five Six Seven Eight Name of School: *
Location of School: *
Secondary
Please Select Nine Ten Eleven Twelve G.E.D. Name of School:
Location of School:
If in high school, are you enrolled in a recognized co-op program?
Please Select Yes No If yes, identify program and school:
College
Please Select One Two Three Four Five Six Seven Eight Name of school:
Location of school:
Degree & Major:
Minor:

Work History

(PLEASE BEGIN WITH MOST RECENT) Company
Phone No. with Area Code
Address
City
City/State/Zip
Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West VirginiA Wisconsin Wyoming DATES OF EMPLOYMENT
Start:

End:

SALARY
Beginning:

Ending:

Job Title:
Supervisor's Name & Title:
Describe duties briefly: Specific Reason for Leaving: Company
Phone No. with Area Code
Address
City
City/State/Zip
Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West VirginiA Wisconsin Wyoming DATES OF EMPLOYMENT
Start:

End:

SALARY
Beginning:

Ending:

Job Title:
Supervisor's Name & Title:
Describe duties briefly: Specific Reason for Leaving: Company
Phone No. with Area Code
Address
City
City/State/Zip
Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West VirginiA Wisconsin Wyoming DATES OF EMPLOYMENT
Start:

End:

SALARY
Beginning:

Ending:

Job Title:
Supervisor's Name & Title:
Describe duties briefly: Specific Reason for Leaving: Company
Phone No. with Area Code
Address
City
City/State/Zip
Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West VirginiA Wisconsin Wyoming DATES OF EMPLOYMENT
Start:

End:

SALARY
Beginning:

Ending:

Job Title:
Supervisor's Name & Title:
Describe duties briefly: Specific Reason for Leaving: Company
Phone No. with Area Code
Address
City
City/State/Zip
Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West VirginiA Wisconsin Wyoming DATES OF EMPLOYMENT
Start:

End:

SALARY
Beginning:

Ending:

Job Title:
Supervisor's Name & Title:
Describe duties briefly: Specific Reason for Leaving: REFERENCES PURPOSES
Have you worked for any of these organizations or attended school under a different name? *
Please Select Yes No If yes, give name and organizations: May we contact the employers listed above? *
Please Select Yes No If not, list the employers you do not wish us to contact and why:

Authorizations & At-Will Employment Agreement

(PLEASE READ CAREFULLY, THEN SIGN AND DATE BELOW)
I CERTIFY THAT I HAVE PERSONALLY COMPLETED THIS APPLICATION. I DECLARE THAT THE INFORMATION PROVIDED IN THIS EMPLOYMENT APPLICATION IS TRUE AND COMPLETE AND I UNDERSTAND THAT ANY FALSE INFORMATION OR SIGNIFICANT OMISSIONS MAY DISQUALIFY ME FROM FURTHER CONSIDERATION FOR EMPLOYMENT AND MAY BE JUSTIFICATION FOR MY DISMISSAL FROM EMPLOYMENT IF DISCOVERED AT A LATER DATE. I AGREE TO IMMEDIATELY NOTIFY THIS COMPANY IF I SHOULD BE CONVICTED OF A CRIME WHILE MY JOB APPLICATION IS PENDING OR DURING MY EMPLOYMENT, IF HIRED. I AUTHORIZE THIS COMPANY TO MAKE AN INVESTIGATION OF ALL INFORMATION CONTAINED IN THIS EMPLOYMENT APPLICATION AND I RELEASE FROM LIABILITY ALL COMPANIES AND CORPORATIONS SUPPLYING SUCH INFORMATION. I UNDERSTAND ANY FALSE ANSWERS, STATEMENTS, OR IMPLICATIONS MADE BY ME ON THIS APPLICATION OR OTHER REQUIRED DOCUMENTS SHALL BE CONSIDERED SUFFICIENT CAUSE FOR DENIAL OF EMPLOYMENT OR DISCHARGE. I SPECIFICALLY AUTHORIZE AND DIRECT MY CURRENT AND FORMER EMPLOYERS TO SUPPLY EMPLOYMENT-RELATED INFORMATION TO THIS COMPANY AND DO HEREBY RELEASE MY CURRENT AND FORMER EMPLOYERS FROM LIABILITY FOR PROVIDING INFORMATION TO THIS COMPANY. UPON TERMINATION OF MY EMPLOYMENT FOR WHATEVER REASON, I RELEASE THIS COMPANY FROM ALL LIABILITY FOR SUPPLYING ANY INFORMATION CONCERNING MY EMPLOYMENT TO ANY POTENTIAL EMPLOYER. I AUTHORIZE THIS COMPANY, IF APPLICABLE, TO REQUEST A COPY OF MY CREDIT REPORT, MOTOR VEHICLE DRIVING RECORD, AND ANY OTHER INVESTIGATIVE REPORT DEEMED NECESSARY THROUGH VARIOUS THIRD PARTY SOURCES. AS REQUIRED BY LAW, UPON REQUEST WITHIN A REASONABLE PERIOD OF TIME, I WILL BE NOTIFIED AS TO THE NATURE AND SCOPE OF SUCH INVESTIGATIONS. I HEREBY AGREE TO SUBMIT TO ANY DRUG TEST REQUIRED OF ME, WHETHER PRIOR TO MY EMPLOYMENT OR IF EMPLOYED BY THIS COMPANY AT ANY TIME THEREAFTER. IF REQUESTED, I WILL TAKE A POST-JOB OFFER PHYSICAL EXAMINATION AND MY EMPLOYMENT, IN THE EVENT I RECEIVE MEDICAL TREATMENT FOR ANY CONDITION, INCLUDING A PHYSICAL, PSYCHOLOGICAL, EMOTIONAL, OR PSYCHIATRIC CONDITION THAT IS JOB-RELATED, I HEREBY AUTHORIZE THE LIMITED RELEASE AND EXCHANGE OF SUCH MEDICAL INFORMATION RELATING TO MY CONDITION BETWEEN THE TREATMENT PROVIDER AND A COMPANY-DESIGNATED PHYSICIAN.

AT-WILL EMPLOYMENT AGREEMENT

I UNDERSTAND AND AGREE THAT NOTHING CONTAINED IN THIS APPLICATION, OR CONVEYED DURING ANY INTERVIEW IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT BETWEEN THE COMPANY AND ME. IN ADDITION, I UNDERSTAND AND AGREE THAT IF YOU EMPLOY ME, IN CONSIDERATION OF MY EMPLOYMENT, MY EMPLOYMENT AND COMPENSATION WILL BE AT-WILL, FOR NO DEFINITE PERIOD OF TIME, AND MAY BE TERMINATED AT ANY TIME, FOR ANY REASON, OR FOR NO REASON AT ALL. I UNDERSTAND THAT ONLY THE COMPANY'S PRESIDENT IS AUTHORIZED TO CHANGE THE EMPLOYMENT-AT-WILL STATUS AND SUCH A CHANGE CAN ONLY BE DONE IN WRITING. I HAVE READ, UNDERSTAND, AND AGREE TO THE ABOVE. Name: *
Date: *

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