EASTERN BAY RESTAURANT

2055 Riverside Dr

Upper Arlington

OH 43221

Tel: (614) 487-1198

E-mail  : contact@easternbayrestaurant.com

JOB APPLICATION FORM

PERSONAL INFORMATION

First Name : ________________________________

Middle Name : __________________________________

Last Name : __________________________________

Address : _____________________________________

    _____________________________________

Phone Number :   (           )   ________________________

Are you eligible to work-in the United States ? Yes              No

If you are under age 18, do you have an employment/age certificates?

yes                           No

POSITION APPLIED FOR :

Days/Hours Available to work

Monday :                   to              Tuesday :                   to

Wednesday :              to             Thursday :                  to

Friday  :                     to               Saturday :                to

Sunday :                    to

What date are you available to start work ?

EMPLOYMENT HISTORY

Present or Last Position :

Empoyer :

Address  :

Position   :

From       :                                      to

May we contact your present Employer?   yes            No

I certify that the information contained in this application is true and complete.  I authorize the verification of any or all information listed above.

Signature :                                             Date :