Location: Cinema Cafe Art Pembroke Meadows
Position(s) Applying for:
Application Date:  
Date Available to Start:
Last Name: First Name:   Middle Initial:
Social Security Number:

Present Address: 
(Street)   City
State Zip Code:

Permanent Address (If different from Present Address:
(Street)   City
State Zip Code:

Telephone Number:
Home:   Work:
Email Address:

Are you 18 years or older? Yes No
Are there any hours or days of the week you cannot work?  Yes No
If so, When?

Desired Pay: per hour per year
Type of Employment: Full Time Part Time

Have you ever applied to this Company before?  Yes No

Where?   When? 
Under What Name?

Education:
Elementary - Name of School # Years Attended
Did you Graduate? Subject/ Major

High School - Name of School # Years Attended
Did you Graduate? Subject/ Major

College - Name of School # Years Attended
Did you Graduate? Subject/ Major

Specialized Training - Name of School
# Years Attended
Did you Graduate? Subject/ Major

Please provide any additional information such as special skills, training, management experience, equipment operation, or qualifications  you feel will be helpful to us in considering your application:


Are you legally permitted to work in the United States without restrictions? Yes No

Have you ever been convicted of any offense in any court except for a minor traffic violations? Yes No
If so, please provide the date and place, charge and disposition where offense occurred:



References:
Reference #1 Name: Address:
Phone Number: Relationship:
Years Acquainted:

Reference #2 Name: Address:
Phone Number: Relationship:
Years Acquainted:

Reference #3 Name: Address:
Phone Number: Relationship:
Years Acquainted:


Current & Former Employers (Most Recent First)

Date (Month/Yr.) Name:
Address: Phone Number:
Position Held: Reason for Leaving:

Date (Month/Yr.) Name:
Address: Phone Number:
Position Held: Reason for Leaving:

Date (Month/Yr.) Name:
Address: Phone Number:
Position Held: Reason for Leaving:

May we contact the employers listed? Yes No
If not, which one(s) and why not?


Please read the following statement carefully before submitting to indicate your understanding:

I understand that, prior to being offered employment, I may be requested to take an employment examination. In the event that I have disability that will affect my ability to take the test, I will so inform the Company prior to the administration of the test so that a reasonable accommodation can be made. Post employment offer, the Company reserves the right to require medical documentation regarding the need for accommodation. 

I certify that the fact contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application may result in termination.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated with or without cause, at any time, with or without notice.

I authorize Cinema Cafe to investigate all information in this application and to secure additional information in the course of that investigation.  I authorize all references, reputation, character and previous employment record.

Enter Your Name to Sign/ Authorize     
Date: