Bolded fields are required!
 
Personal Information
First Name: Last Name:
Address 1:
Address 2:
City: State:
Zip: E-Mail:
Phone: Referred By:
Employment Desired

Date you can start(mm/dd)

Ever applied to this company before?

No Yes

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver’s license, birth certificate, Green Card, etc.) within 3 days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.
Additional Information
Any hours, shifts, days you cannot work? No Yes
Please specify:
Have you ever been employed with us before? No Yes
If yes, give date (mm/yyyy):
Do you have any relatives who are presently (or have formerly been) employed by US 23 Drive-In Theater? No Yes
Please name any friends or individuals you know who are presently employed by US 23 Drive-In Theater.
Have you ever been the subject of disciplinary charges and/or have you ever been subject to disciplinary action by prior or current employer? No Yes
If yes, please give details.
Education History
Name & Location of School Highest Grade Completed or Degree Earned Subjects Studied
Grammar School
High School
College
Trade or Business School
Employment History
List last four employers, starting with most current one first.
Date
(mm/yyyy)
Name & Address of Employer Salary Position Reason for Leaving
From:

To:


From:

To:
From:

To:
From:

To:

Are you currently employed?
No Yes
May we contact your current employer?
No Yes
If no, please explain why you don't want the company contacted?:
I hereby certify that the information provided in this Application for Employment is true, correct and complete. Any misstatement or omission of fact on this application may result in the rejection of my application or in my termination, if employed by US 23 Drive-In Theater. I understand that acceptance of an offer of employment does not create a contractual obligation upon US 23 Drive-In Theater to continue to employ me in the future. I authorize US 23 Drive-In Theater to contact any educational institutions, former employers, or other individuals and entities having information concerning me to make inquiries and obtain information, including personnel files, relevant to my background, performance and abilities as an employee or relating to my application for employment. I hereby release all such entities and individuals from any and all claims, including but not limited to claims of defamation, associated with the release of disclosure of such information to US 23 Drive-In Theater. I agree that a copy of this authorization and release may be accepted with the same authority as the original.

Check this box to certify that you have read and accept the above statement.