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Employment Application Form

Position(s) you'd like to apply for: *

000-000-0000 or (000) 000-0000

Upload Resume/Cover Letter (pdf, doc, docx, jpg, jpeg):

Applicant Information

Are you legally eligible to work in the United States? *
Are you at least 18 years old? *
Have you applied to Peach Valley Cafe before? *

Date available to start work

Have you ever pled "guilty" or "no contest", or been convicted of a crime? *

Educational Background & References

Please list three business/work, school or personal references who are not related to you and are not previous supervisors. Name / Address / Telephone # / Relationship / Years Known *

Work History

Please begin with most recent or current employer.

May We Contact? *

000-000-0000 or (000) 000-0000

Employment Dates * (Required)

Beginning -Ending

May We Contact?

From - To

Beginning - Ending

May We Contact?

From - To

Beginning - Ending

Applicant Statement

I certify that all of the information I have provided is true, complete and correct. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document will disqualify me from further consideration of employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document will be cause for my dismissal at any time without prior notice. I authorize Peach Valley Cafe to contact my prior employers, and other sources of information regarding my background, credit history, criminal history and/or driving history and I hereby authorize and direct each such employer and source of information to answer any and all questions regarding my prior employment and background. I hereby indemnify Peach Valley Cafe, each of my prior employers and each of the other sources of information contacted and agree to hold them harmless from any and all claims arising from this authorization and direction.

Please check the box if you agree.

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