Applicant Information
Full Name
Date of Application
Address (City, State, Zip Code)
Telephone Number
Email Address

Employment Position
Applying For:	- Choose an Option - Cook Food Prep Cashier Server Hostess Food Runner Barista Dishwasher Bakery Assistant
How Did You Hear About This Position?
What Days Are You Available For Work?
What Hours or Shifts Are You Available to Work?
On What Date Can You Start Working If You Are Hired?
Do You Have Reliable Transportation To And From Work?	- Choose an Option - Yes No

Personal Information
Have You Ever Applied To Work For Itavie Before?	- Choose an Option - Yes No
If You Have Applied, When?
Do You Have Any Friends, Relatives, or Acquaintances Working For Itavie?	- Choose an Option - Yes No
If Yes, State The Name and Relationship
Are You 18 Years of Age or Older?	- Choose an Option - Yes No
Are You A U.S. Citizen or Approved to Work in the United States?	- Choose an Option - Yes No
What Document Can You Provide as a Proof of Citizenship or Legal Status?
Will You Consent To a Mandatory Controlled Substance Test?	- Choose an Option - Yes No
If Yes, Please Describe Accommodations Required Below
Have You Ever Been Convicted of a Criminal Offense? (Felony or Misdemeanor)	- Choose an Option - Yes No
If Yes, Please State the Nature of the Crime(s), When Convicted, and Disposition of the Case

Requested Information
Do You Have Any Conditions Which Would Require Job Accommodations?	- Choose an Option - Yes No

Job Skills/Qualifications
Please List Below the Skills and Qualifications You Possess for the Position for Which You Are Applying For

Education and Training
High School (Name, Address, Year Graduated, Degree Earned)
College/University (Name, Address, Year Graduated, Degree Earned)
Vocational School/Specialized Training

Military
Are You A Member of The Armed Forces?	- Choose an Option - Yes No
What Branch of the Military Did You Enlist?
What Was Your Military Rank When Discharged?
How Many Years Did You Serve in the Military?
What Military Skills Do You Possess That Would Be An Asset For This Position?

First Employer
Employer Name:
Job Title:
Supervisor Name:
Employer Address: (City, State, & Zip Code)
Employer Telephone:
Dates Employed:
Reason For Leaving:

Second Employer
Employer Name:
Job Title:
Supervisor Name:
Employer Address: (City, State, & Zip Code)
Employer Telephone:
Dates Employed:
Reason For Leaving:

Additional Information: