Requested Information
Position(s) Applied For:
How did you learn about us?	Friend Relative Newspaper Walk-In Employee Other

Applicant Information
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Home Number:
Cell Number:
Social Security No. (Voluntary):

Employment Information
If you are under 18 years of age, can you provide required proof of your eligibility to work:	- Choose an Option - Yes No
Have you ever filed an application with Lefty's before?	- Choose an Option - Yes No
If yes, give date:
Have you ever been employed with Lefty's before?	- Choose an Option - Yes No
If yes, give date:
Do any of your friends or relatives, other than spouse, work here?	- Choose an Option - Yes No
Are you currently employed?	- Choose an Option - Yes No
May we contact your employer?	- Choose an Option - Yes No
Are you legally eligible for employment in the U.S.? proof of citizenship or immigration status will be required upon employment.	- Choose an Option - Yes No
Have you been convicted of a crime? Admission of crime may not constitute denial of employment.	- Choose an Option - Yes No
Date you are available to work:
What is your desired salary?
Are you available to work:	- Choose an Option - Full-Time Part-Time Temporary
Mornings and/or Evenings?	Mornings Evenings
Would you be interested in catering?	- Choose an Option - Yes No
Do you have transportation?	- Choose an Option - Yes No
List the days/times you are not available to work?

Education
Elementary School Name and Address:
Elementary School Course of Study:
Elementary School - Number of Years Completed:
Elementary School Diploma or Degree:
Middle School Name and Address:
Middle School Course of Study:
Middle School - Number of Years Completed:
Middle School Diploma or Degree:
High School Name and Address:
High School Course of Study:
High School - Number of Years Completed:
High School Diploma or Degree:
College/University Name and Address:
College/University Course of Study:
College/University - Number of Years Completed:
College/University Diploma or Degree:
Other (specify) Name and Address:
Other (specify) Course of Study:
Other (specify) - Number of Years Completed:
Other (specify) Diploma or Degree

Employment Experience (1)
Company:
Phone Number:
Address:
City/State/Zip:
Date of Employment (From):
Date of Employment (To):
Beginning Salary:
Ending Salary:
Job Title:
Supervisor's Name and Title:
Describe Duties:
Reason for Leaving:

Employment Experience (2)
Company:
Phone Number:
Address:
City/State/Zip:
Date of Employment (From):
Date of Employment (To):
Beginning Salary:
Ending Salary:
Job Title:
Supervisor's Name and Title:
Describe Duties:
Reason for Leaving:

Employment Experience (3)
Company:
Phone Number:
Address:
City/State/Zip:
Date of Employment (From):
Date of Employment (To):
Beginning Salary:
Ending Salary:
Job Title:
Supervisor's Name and Title:
Describe Duties:
Reason for Leaving

Employment Experience (4)
Company:
Phone Number:
Address:
City/State/Zip:
Date of Employment (From):
Date of Employment (To):
Beginning Salary:
Ending Salary:
Job Title:
Supervisor's Name and Title:
Describe Duties:
Reason for Leaving:

ADDITIONAL INFORMATION
Summarize special job-related skills and qualifications acquired from employment or other experience:

References (1)
Name:
Phone Number:
Address:
City:
State:
Zip:

References (2)
Name:
Phone Number:
Address:
City:
State:
Zip:

References (3)
Name:
Phone Number:
Address:
City:
State:
Zip:

APPLICANT'S 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. If applicable, I authorize Lefty’s Barbecue Unlimited, Inc. to request a copy of my motor vehicle driving record and other investigative report deemed necessary through various third party sources. As required by law, upon request with a reasonable period of time, I will be notified as to the nature and scope of such investigations. A criminal conviction will not automatically disqualify applicant from employment. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I understand that this application is not intended to be a contract of employment. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Lefty’s Barbecue Unlimited, Inc. is of an “at will” nature, which means that the Employee may resigned at any time and Lefty’s Barbecue Unlimited, Inc. may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of Lefty’s Barbecue Unlimited, Inc. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Lefty’s Barbecue Unlimited, Inc.
Signature of Applicant:
Date: