THE ULTIMATE BAR & GRILL EMPLOYMENT APPLICATION
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status.
Position(s) applied for:
How did you find out about this job?	Please choose one Website Search Newspaper Employee Walk-in Rela>tive Other
If Other, please specify:
Why are you seeking a new job at this time?
Applicant Information
Full Name:
Email Address:
Street Address:
City, State, Zip:
Social Security No:
Phone Number:
If hired, do you have a reliable means of transportation to get to work?
Describe:
Are you at least 18 years old?	Select One Yes No
If you are under 18 years of age, can you furnish a work permit?	Select One Yes No
Will you have any problem acquiring a liquor permit should the position you are applying for require it?	Select One Yes No
Are you legally eligible for employment in the U.S.? Select One Yes No (Proof of U.S. citizenship or immigration status is required if hired.)
Have you been convicted of a crime? Select One Yes No (Massachusetts applicants should not include misdemeanor convictions; California applicants should not include marijuana-related convictions that occurred more than 2 years prior to the application date.)
If yes, state the nature of the offense and the dates and disposition of the case. (NOTE: Existence of a criminal record does not constitute an automatic bar to employment.)
Employment Information
Are you seeking full time, part time or temporary employment?	Select One Full Time Part Time Temporary
What hours and shift(s) would you prefer to work?
List times you are not available to work.
Are you willing to work:	Overtime? Select One Yes No Weekends? Select One Yes No Holidays? Select One Yes No
Are you currently employed?	Select One Yes No
If hired, when would you be able to start?
Have you ever worked for this organization before?	Select One Yes No
If yes, name used:
List any friends or relatives employed by this company:
Have you ever been discharged or asked to resign from any position?	Select One Yes No
If yes, please describe:
Are you able to perform all these tasks with or without reasonable accommodation?	Select One Yes No
Please describe which tasks, if any, you will need accommodation to perform, and explain what type of accommodation you will need:
Education
Select the highest level achieved:	Elementary/Secondary: Select One 1 2 3 4 5 6 7 8 9 10 11 12 G.E.D.
Name of School:
Location of School:
If in high school, are you enrolled in a recognized co-op program?	Select One Yes No
If yes, identify program and school:
Select the highest level achieved:	College: Select One None 1 2 3 4 5 6 7 8
Name of College:
Location of College:
Degree/Major:
Minor:
Work History (Please begin with most recent)
Company:
Phone Nunder with Area Code:
Full Address:
Dates of Employment:	From:     To:
Job Title:
Describe duties briefly:
Specific reason for leaving:
Company:
Phone Nunder with Area Code:
Full Address:
Dates of Employment:	From:     To:
Job Title:
Describe duties briefly:
Specific reason for leaving:
Company:
Phone Nunder with Area Code:
Full Address:
Dates of Employment:	From:     To:
Job Title:
Describe duties briefly:
Specific reason for leaving:
Company:
Phone Nunder with Area Code:
Full Address:
Dates of Employment:	From:     To:
Job Title:
Describe duties briefly:
Specific reason for leaving:
May we contact the employers listed above?	Select One Yes No
If not, list the employers you do not wish us to contact and why:
I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consid-eration for employment and may be justification form my dismissal from employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime while my job application is pending or during my employ-ment, if hired. I Agree       I Disagree
BEFORE YOU SUBMIT THIS FORM - Please verify all information above. Once you have completely reviewed this application, submit the form below.

---

Questions, email employment@theultimatebarandgrill.com.