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Application 2012

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432 E. College Ave.

State College, PA 16801 (814) 237-7505


NAME ___________________________________ DATE ________________
LAST 4 DIGITS SS # _______________ DESIRED POSITION(S) __________
DATE AVAILABLE ____________ DESIRED LENGTH OF EMPLOYMENT ______
PRESENT ADDRESS ______________________________________________
______________________________________________
PERMANENT ADDRESS ___________________________________________
______________________________________________
CELL PHONE______________________LOCAL PHONE ___________________
EMAIL ADDRESS_________________________________________________
MAXIMUM NUMBER OF HOURS PER WEEK DESIRED ____________________
HOURS AVAILABLE (PLEASE BE VERY SPECIFIC)
MONDAY ______________________________________________________
TUESDAY ______________________________________________________
WEDNESDAY ___________________________________________________
THURSDAY _____________________________________________________
FRIDAY _______________________________________________________
SATURDAY _____________________________________________________
SUNDAY _______________________________________________________

ARE YOU LAWFULLY ABLE TO WORK IN THE US?


HAVE YOU EVER BEEN CONVICTED OF A FELONY?
DO YOU KNOW ANYONE THAT WORKS AT Lemongrass? (If yes, who???)
DO YOU HAVE OTHER COMMITMENTS YOU WOULD LIKE US TO TAKE INTO
CONSIDERATION?

EMPLOYMENT EXPERIENCE (START WITH THE MOST RECENT)


EMPLOYER ___________________________________ DATES __________________
ADDRESS ____________________________________________________________
TELEPHONE ____________________________ SUPERVISOR __________________
WORK PERFORMED _____________________________________________________
REASON FOR LEAVING ______________________ _____ HOURLY RATE __________

EMPLOYER ___________________________________ DATES __________________


ADDRESS ____________________________________________________________
TELEPHONE ____________________________ SUPERVISOR __________________
WORK PERFORMED _____________________________________________________
REASON FOR LEAVING ______________________ _____ HOURLY RATE __________

EMPLOYER ___________________________________ DATES __________________


ADDRESS ____________________________________________________________
TELEPHONE ____________________________ SUPERVISOR __________________
WORK PERFORMED _____________________________________________________
REASON FOR LEAVING ______________________ _____ HOURLY RATE __________

LEMONGRASS IS A SERVICE-ORIENTED BUSINESS. WHAT DOES GOOD SERVICE


MEAN TO YOU?

APPLICANTS STATEMENT
I CERTIFY THAT ANSWERS GIVEN HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I
AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR
EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION. I UNDERSTAND
THAT MISREPRESENTATION OR WILLFULL OMISSION OF FACTS CALLED FOR ON THIS APPLICATION IS
JUST CAUSE FOR DISMISSAL. I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, UNLESS OHTERWISE
DEFINED BY APPLICABLE LAW, ANY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION IS OF AN
AT WILL NATURE WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANYTIME AND THE EMPLOYER
MAY DISCHARGE THE EMPLOYEE AT ANY TIME WITH OR WITHOUT CAUSE.

SIGNATURE _____________________________________ DATE _______________

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