Employment Application

540 Water Street
Yorktown, VA 23690
757-886-9964

Online Employment Application

Download -> Employment Application

Applicant Information

Full Name

Address

City

State

Zip

Phone

Email Address

Date Available

Social Security No.

Desired Salary

Position Applying For Wait Staff Dishwasher Cook Other

Other Position

Are you a U.S. citizen Yes No

Are you authorized to work in the U.S.? Yes No

Have you ever worked for Yorktown Pub? Yes No

When did you work for Yorktown Pub?

Have you ever been convicted of a felony? Yes No

Please explain the conviction

Education

High School Education

High School

Address

Attended From

Attended To

Did You Graduate? Yes No

Degree

College Education

College

Address

Attended From

Attended To

Did You Graduate Yes No

Degree

Other Education

Address

Attended From

To

Did You Graduate Yes No

Degree

References
Please List Two Professional References

Reference One

Full Name

Relationship

Company

Phone

Reference Two

Full Name

Relationship

Company

Phone

Previous Employment

Company

Company 1

Phone

Address

Job Title

Starting Salary

Ending Salary

Responsibilities

Employed From

Employed To

Reason for Leaving

May we contact your previous supervisor for a reference? Yes No

Company

Company 2

Phone

Address

Job Title

Starting Salary

Ending Salary

Responsibilities

Employed From

Employed To

Reason for Leaving

May we contact your previous supervisor for a reference? Yes No

Company

Company 3

Phone

Address

Job Title

Starting Salary

Ending Salary

Responsibilities

Employed From

Employed To

Reason for Leaving

May we contact your previous supervisor for a reference? Yes No

Military Service

Have you served in the military? Yes No

Which Branch?

Served From

Served To

Rank at Discharge

Type of Discharge

If other than honorable please explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my appplication or interview may result in my release.

Signature

Date

Thank you for submitting an employment application. We will review your application and contact you if a position is available.