Applicant

Date of this Application Social Security # E-Mail Address

1. Elegibility

Yes No Are you elegible to work in the U.S.? If hired you must complete Section 1 of the Immigration Form in this Application.

2. 18 or older

Yes No Are you 18 or older?

3. Name

Last Name First Name Middle Initial

4. Address

AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA QU RI SA SC SD TN TX UT VA VT WA WI WV WY   Address City State Zip Code

5. Address continued

How long have you lived there? Phone Number

6. Current Employee

Yes No Do you know anyone presently employed here? If yes, who?

7. Desired Position

Position Desired

8. Preferred Working Hours

Full Time Part Time Days Nights Permanent Temporary Anytime Available Please Check which of the following you prefer to work

9. Availability

Date when you will be available for work, if hired

10. Capabilities

Yes No      The job you are applying for will essentially, from time to time, require: (A) reading and writing legibly in English, (B) lifting and carrying loads of upwards of 25lbs., (C) bending and stooping to retrieve similar or smaller items. Are you able to perform all of these job functions?     If NO, state which functions     you cannot perform

11. Weekends & Holidays

Yes No The job for which you are applying for may require work on Saturdays, Sundays and Holidays. While reasonable accommodations can be made for you, are you willing to work such a schedule?

12. Transportation

How long will it take you to get from home to work? What type of transportation will you use?

13. Employment Experience (Most current first)

Name of Company Date employment started Date employment ended Name of supervisor Phone number Job title Reason for leaving Name of Company Date employment started Date employment ended Name of supervisor Phone number Job title Reason for leaving Name of Company Date employment started Date employment ended Name of supervisor Phone number Job title Reason for leaving

14. Education: What is the name of the last school you attended and the last year completed?

School Last year completed College Last year completed

15. Education: Current School

Yes No      Are you attending school now?     School Subject

16. Food Service Training

Yes No Are you attending or have you attended any food service training programs such as service training, bartending or cook apprenticeship classes? If yes, please describe

17. Business Machines

Cash Register Adding Machine PC/Computer Point of Sales Equipment Typewriter What business machines can you operate?

18. References: Please list two Personal References (Do not include Relatives)

Name Company Position Phone #         Name Company Position Phone #

19. Past History

Yes No Have you ever been convicted of, or pled guilty to any involved theft, sexual abuse, and destruction of property of physical violence? If yes, please explain in detail

20. Drug Free Policy

Yes No Crazy Pinz is a drug free work place. Do you understand that we are committed to provide for its employees and guest a drug free work place at all time?

21. Character Inquiries

Yes No Before a final employment decision is made routine inquiries about the information discussed in this application and to discuss such information with others: which may elicit knowledge of your character and/or reputation?

22. Information

Yes No Do you understand, that upon your written request to us, you may obtain certain information as to the nature and scope of any reports received?