Application for Employment

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

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.

Name

Address

Major

Number of Years

Diploma/Degree

Name

Address

Major

Number of Years

Diploma/Degree

Name

Address

Major

Number of Years

Diploma/Degree

Company

Address

Name of Supervisor

Job Title/Duties Performed

Phone # (Area Code)

Dates (from-to)

Reason for leaving

Starting Pay

Ending Pay

Company

Address

Name of Supervisor

Job Title/Duties Performed

Phone # (Area Code)

Dates (from-to)

Reason for leaving

Starting Pay

Ending Pay

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?

Name

Relationship or Title

Phone # (Area Code)

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