Date of Review(Month/Day/Year): Position Applied For:
Address: City: State: California Zip:
Phone: Mobile: Your Email:
Date Available to Start: Social Security#: Salary Requirement:
If you are under 18 and we require a work permit, can you furnish one?
If no, please explain:
Have you ever worked for Mirchi Cafe? Yes No If yes, when?
Are you a citizen of the United States? Yes No
If not, are you legally allowed to work in the United States?
Type of employment desired: Full-Time Part-Time Temporary
Have you ever pleaded "guilty," no contest," or been convicted of a crime? Yes No
If yes, give dates and details:
Answering "yes" to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.
SUMMARIZE YOUR SPECIAL SKILLS:
Dates of Employment:From: To: Position Held:
Address: Phone: Manager Name:
Starting Salary: Ending Salary:
Reason for leaving:
May we contact this employer for a reference? Yes No
In the event I am employed, I understand that any false or misleading information given in my application or interview(s) may result in discharge.