Application for Employment

    Personal Information

    First Name
    Last Name
    Email
    Phone
    Street Address
    Address City
    ZIP Code
    Are you UNDER 18 years of age?
    If "Yes", DOB


    Were you referred by anyone and who?


    Do you have any relatives working for The Hearthstone?
    If "Yes", give name, relationship, and department


    Have you ever been previously employed by The Hearthstone Bistro?
    If "Yes", please provide dates of employment (from-to)


    Name of Supervisor
    Reason for Leaving
    Position Desired
    Employment Desired
    Desired hours/week



    Hours Available (From-To)

    Monday
    Tuesday
    Wednesday
    Thursday
    Friday
    Saturday
    Sunday
    Do you have any known future scheduling conflicts? (ie. Family Vacation, School, Sports, Clubs, etc.)
    If "Yes", please provide dates and/or times of conflict.


    Education (Name and address of school)

    College

    Name
    Address
    Major
    Number of Years
    Diploma/Degree


    High school

    Name
    Address
    Major
    Number of Years
    Diploma/Degree


    Other Education

    Name
    Address
    Major
    Number of Years
    Diploma/Degree


    Employment (List most recent job first)

    Employment #1

    Company
    Address
    Name of Supervisor
    Job Title/Duties Performed
    Phone # (Area Code)
    Dates (from-to)
    Reason for leaving
    Starting Pay
    Ending Pay


    Employment #2

    Company
    Address
    Name of Supervisor
    Job Title/Duties Performed
    Phone # (Area Code)
    Dates (from-to)
    Reason for leaving
    Starting Pay
    Ending Pay


    Employment #3

    Company
    Address
    Name of Supervisor
    Job Title/Duties Performed
    Phone # (Area Code)
    Dates (from-to)
    Reason for leaving
    Starting Pay
    Ending Pay
    May we contact your present employer?


    Personal References (Excluding relatives and employers you've listed above)

    Reference #1

    Name
    Relationship or Title
    Phone # (Area Code)


    Reference #2

    Name
    Relationship or Title
    Phone # (Area Code)


    I certify that the information contained in this application is
    correct to the best of my knowledge and understand that
    falsification of this information is grounds for dismissal in
    accordance with The Hearthstone Bistro. I authorize the
    references and supervisors listed above to give you any and
    all information concerning my previous employment,
    including wage and salary history, and any pertinent
    information they may have personal or otherwise and
    release all parties from all liability for any damage that may
    result from furnishing them to you. In consideration of my
    employment, I agree to conform to the rules and regulations
    of Employer and understand that my employment is at will
    and can be terminated at any time with or without cause, at
    the option of either the Company or my- self. I understand
    that no representative of Employer other than the Owner(s)
    has the authority to enter into any agreement or promise for
    employment related details of any kind, including a
    guarantee of employment for a specific period of time,
    bonus, promotion, or pay raise. I agree that I shall not levy
    any claim, lawsuit, charge or cause of action of any kind
    arising out of my employment with SJ Acquisition Enity LLC
    (dba The Hearthstone Bistro) for the termination of my
    employment with the Company any later than the 180th day
    after my termination of employment and that my agreement
    to shorten any applicable statute of limitations under any
    federal or state law is without prejudice to my rights to bring
    any such claim should I so choose. Upon hire, I agree that
    this application forms a binding contract of the terms stated
    above.
    Signature
    Date