EMPLOYMENT APPLICATION

Name*
First Middle Initial Last
Email Address
Phone Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Job applying for*

Most recent job
Company*

If no previous work experience, type "N/A"
Address
Street Address City State
Phone
Job title
Description
Supervisor
Dates worked
From To
Salary
Reason for leaving
Are you 18 years of age or older?*
- Yes
- No
Are you of legal age to serve alcoholic beverages? (Age requirements may vary by state.)
- Yes
- No
Are you willing to work flexible hours including nights, weekends, and holidays?*
- Yes
- No
How many hours per week do you expect to work?*
- 0 to 10
- 11 to 20
- 21 to 30
- 31+

The Secretary of Health and Human Services has determined that certain diseases, including hepatitis A, salmonella, shigella, staphylococcus, streptococcus, giardia, and campylobacter may prevent you from serving food or handling food equipment in a sanitary health fashion. An essential function of this job involves handling and serving food, foodservice equipment, and utensils in a sanitary and healthy fashion.
Is there any reason why you cannot perform the essential functions of this job?*
- Yes
- No
By submitting this form, you are stating that the information contained is correct to the best of your knowledge and understand that any omission or erroneous information is grounds for dismissal in accordance with the policy of Madrones. You authorize the references listed above to give us any and all information concerning your past employment and pertinent information they may have, personal or otherwise, and release all parties from the liability for any damage that may result from furnishing the same to us. If applicable to your employment, you have read and understood the notice regarding polygraph tests and your rights under Maryland law.
Name
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Employment Application