262-334-5400
1014 S Main St, West Bend, WI 53095
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Employment Application
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General Information
First Name
*
Middle Name
Last Name
*
Email
*
Day Phone
Evening Phone
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
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District of Columbia
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Northern Mariana Islands
Ohio
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Puerto Rico
Rhode Island
South Carolina
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Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date of Application
*
MM slash DD slash YYYY
Are you legally authorized to work in the U.S.?
*
If hired, you will be required to provide proof of work authorization
Yes
No
Are you at least 18 years old?
*
If not, your employment will be subject to verification that you meet state/federal minimum age requirements for the type of work you are applying for and have obtained a valid work permit
Yes
No
Are there other names under which you have worked or attended school?
*
Yes
No
If yes, please list for reference checking purposes
*
Have you ever been convicted of a crime or pleaded no contest for an offense or violation other than minor traffic violations?
*
Yes
No
If yes, explain 1) Nature of Crime, 2) Date of Conviction, and 3) State in Which Convicted
*
Have you ever worked at this company before?
*
Yes
No
If yes, when?
*
Position Applying For
Position
*
Manager
Cook
Preferred Pay Range
*
When can you start?
*
MM slash DD slash YYYY
Time Commitment
*
Part Time
Full Time
Are you available to work overtime?
*
Yes
No
Are you available to work weekends?
*
Yes
No
Education
Please fill out all applicable fields.
High School
Name and Location
Last year completed
9
10
11
12
Diploma/Degree and Course of Study
Graduation date, if applicable
MM slash DD slash YYYY
Undergraduate
Name and Location
Last year completed
1
2
3
4
Diploma/Degree and Course of Study
Graduation date, if applicable
MM slash DD slash YYYY
Graduate
Name and Location
Last year completed
1
2
3
4
Diploma/Degree and Course of Study
Graduation date, if applicable
MM slash DD slash YYYY
Other (specify)
Name and Location
Last year completed
1
2
3
4
Diploma/Degree and Course of Study
Graduation date, if applicable
MM slash DD slash YYYY
Resume (Optional)
Resume
If you upload a resume, you do not have to complete the Employment History section below.
Max. file size: 10 MB.
Employment History
Please supply at least ten years of employment, or all of previous employment, starting with the most recent.
Employer 1
Name of Employer
Phone
Address
Street Address
City
ZIP / Postal Code
Job Title
Name of Supervisor
Reason for Leaving
Hourly Rate / Salary (Start)
Hourly Rate / Salary (End)
If currently employed, may we contact as a reference?
Yes
No
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Employer 2
Name of Employer
Phone
Address
Street Address
City
ZIP / Postal Code
Job Title
Name of Supervisor
Reason for Leaving
Hourly Rate / Salary (Start)
Hourly Rate / Salary (End)
If currently employed, may we contact as a reference?
Yes
No
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Employer 3
Name of Employer
Phone
Address
Street Address
City
ZIP / Postal Code
Job Title
Name of Supervisor
Reason for Leaving
Hourly Rate / Salary (Start)
Hourly Rate / Salary (End)
If currently employed, may we contact as a reference?
Yes
No
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Employer 4
Name of Employer
Phone
Address
Street Address
City
ZIP / Postal Code
Job Title
Name of Supervisor
Reason for Leaving
Hourly Rate / Salary (Start)
Hourly Rate / Salary (End)
If currently employed, may we contact as a reference?
Yes
No
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
References
Please list four references, who are not related to you, who can provide us with information about your qualifications to perform the job for which you are applying.
Reference 1
Name
Occupation
Phone
Address
Street Address
City
ZIP / Postal Code
Relationship
How long have you know this individual?
Reference 2
Name
Occupation
Phone
Address
Street Address
City
ZIP / Postal Code
Relationship
How long have you know this individual?
Reference 3
Name
Occupation
Phone
Address
Street Address
City
ZIP / Postal Code
Relationship
How long have you know this individual?
Reference 4
Name
Occupation
Phone
Address
Street Address
City
ZIP / Postal Code
Relationship
How long have you know this individual?
Performance Ability
Please review the job description and physical demands of the job applying for.
With respect to this particular job, are you able to perform the tasks outlined in these materials with or without accomodations?
*
Yes
No
Are you currently on layoff with another company?
*
Yes
No
Signature
*
Entering your name in this field denotes a signature and certifies that your answers are true and complete to the best of your knowledge.
Comments
This field is for validation purposes and should be left unchanged.
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