The Table DeLand Job Application

Please Print, Complete & Deliver In Person To: 100 E. New York Avenue | DeLand, FL 32724
Availability
Place an "X" in the shifts you are available to work (hours may vary) Position(s) Applying For
Availability Mon. Tue. Wed. Thurs. Fri. Sat. Sun. Circle All That Apply:
Open (8a - 4p) Cook Server

Close (4p - 10p) Dishwasher Bartender

Other Host Expeditor

How many hours per week are you willing to work? 0 - 16 16 - 25 25 - 35 35+

Personal Information
Name (Last, First, Middle) Phone Number Email Address

Address (Street, City, State, Zip) Desired Pay Rate

Are you 18 years or older? yes no Have You Ever Been Convicted Of A Felony? yes no

If Ever Convicted of a Felony, Please Explain:

_________________________________________________________________
A conviction record does not necessarily disqualify you from employment, factors such as the date of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.

Employment History
Month & Year Name & Phone Number of Employer Pay Position Reason for Leaving
From: $

To: Per:

From: $

To: Per:

From: $

To: Per:

Professional References (Not Related & Known For At Least One Year)
Name Phone Number Business Association Years Known
1.

2.

3.
Disclosure:
The Age Discrimination in Employment Act prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or
otherwise, and release all parties from all liability for any damage that may result from furnishing the same to you.
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 at any time without any prior notice."

Signature: ________________________________________________ Today's Date: ____________________________