& CATERING
2010 Lincoln Way East, Chambersburg, Pa 17201
Restaurant - 717-264-2563 Catering - 717-261-0695
Fax - 717-264-7708
website - Online@ www.Dodies.net
APPLICATION FOR EMPLOYMENT
Position or Shift applying for________________Expected Salary____________ Date__/__/__
Phone #____________Social Security # ______________ work phone #__________________ (Print) Full Name ___________________ ____________________ _____________________
(LAST) (MIDDLE) (FIRST)
Present Address___________________________ _____________________ _____ _____________
(Number and Street) (Town or City) (State) (Zip)
Previous Address__________________________ _____________________ _____ ____________
(Number and Street) (Town or City) (State) (Zip)
Are you a U.S. Citizen? [ ] yes [ ] no Are you older than 18 and less than 70? [ ] yes [ ] no
__________________________________________________________________________________________
MEDICAL INFORMATION
- Do you have any Physical impairments that would affect your performance on the job? [ ]yes [ ]no
If yes please explain___________________________________________________________________
__________________________________________________________________________________________
MILITARY INFORMATION
- Were you a member of the US armed services? [ ] yes [ ] no
If yes ____ to ____ __________
(Dates) (Branch)
__________________________________________________________________________________________
EDUCATION
- Circle the last year that you attended school
8 or less 9 10 11 12 College 1 2 3 4 ____________________
High School Co-Op Study student [ ]yes[ ]no (School Name)
Are You currently in school? [ ]yes [ ]no
_______________________________________________________________________________________________________
EMPLOYMENT HISTORY
Company_______________ From ___ to ___ List of duties_____________________________________
Address________________ Phone#____________ ____________________________________
Supervisor______________ Position____________ ____________________________________
Reason For Leaving ___________________________________________________________________________
_______________________________________________________________________________________________________
Company_______________ From ___ to ___ List of duties_____________________________________
Address________________ Phone#____________ _____________________________________
Supervisor______________ Position____________ _____________________________________
Reason For Leaving __________________________________________________________________________
_______________________________________________________________________________________________________
Compaany______________ From ___ to ___ List of duties____________________________________
Address________________ Phone#____________ ____________________________________
Supervisor______________ Position____________ ____________________________________
Reason For Leaving __________________________________________________________________________
_______________________________________________________________________________________________________
IF ALL OF THE INFORMATION ABOVE IS CORRECT TO THE BEST OF YOUR KNOWLEDGE PLEASE SIGN BELOW
x___________________________ ___/___/___
AN EQUAL OPPORTUNITY EMPLOYER