Cafe Provencal Employment Application

If you are interested in joining The Cafe Provencal staff at please fill out this pre-employment application.

Personal Information

First Name

M.I.

Last Name

Present Address

City

State

Zip

Phone Number

Permanent Address

City

State

Zip

Phone Number

E-Mail

Are You 18 Years Or Older? Yes No

Employment Desired

Position

Salary or Wage Desired

You are available to work Full Time Part Time

Employment Availability

Date You Can Start

Are you available to work holidays
Yes No

Available Shift Preference
Days Nights Both

Are you currently employed
Yes No

If so, may we inquire of your present employer?

Are you currently enrolled in school
Yes No

If so, may we inquire name of the school?

General Information

Have you applied to our company before
Yes No

Date Applied

Position

Have you worked for our company before
Yes No

Date Worked

Position

If Yes, Was termination
Voluntary Involuntary

Exact reason for leaving

Name of last supervisor at our company

Who referred you to our company

Former Employment Information

Previous Employment 1

Name of present or last employer

Address

Starting Date

Ending Date

Hr/Mo Starting Salary

Hr/Mo Final Salary

Job Title

Name of immediate supervisor

Title of immediate supervisor

May we contact your immediate supervisor Yes No

Description of work

Was termination
Voluntary Involuntary

Exact reason for leaving

Previous Employment 2

Name of last employer

Address

Starting Date

Ending Date

Hr/Mo Starting Salary

Hr/Mo Final Salary

Job Title

Name of immediate supervisor

Title of immediate supervisor

May we contact your immediate supervisor Yes No

Description of work

Was termination
Voluntary Involuntary

Exact reason for leaving

Previous Employment 3

Name of last employer

Address

Starting Date

Ending Date

Hr/Mo Starting Salary

Hr/Mo Final Salary

Job Title

Name of immediate supervisor

Title of immediate supervisor

May we contact your immediate supervisor Yes No

Description of work

Was termination
Voluntary Involuntary

Exact reason for leaving

Education Information

Grammar School Name

Years Attended

Graduated
Yes No

Major & Minor Studies

High School Name

Years Attended

Graduated
Yes No

Major & Minor Studies

College Name

Years Attended

Graduated
Yes No

Major & Minor Studies

Trade, Bus. Or Correspondence School Name

Years Attended

Graduated
Yes No

Major & Minor Studies

References

Give the names of three persons not related to you, whom you have known at least one year.

1. Reference Name

Address

Business

Years Acquainted

2. Reference Name

Address

Business

Years Acquainted

3. Reference Name

Address

Business

Years Acquainted

Miscellaneous

Subject of special or research work

Special training

Do you have any commitments to another entity, business or person that might affect your employment with our company?
Yes No

Explain fully

Agreement

I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.

I HAVE READ AND AGREE TO THE ABOVE STATEMENT