Date of Application




Please Note: A record of conviction will not necessarily bar you from employment. A criminal conviction will be considered only in relation to the job for which you are applying. The seriousness and nature of the offense, the time elapsed and rehabilitation will be taken into account. It is only necessary to include convictions that have not been expunged from the records.

Are You Seeking

What Position Are You Seeking

Available To Begin Work

Circle Days / Shifts You Are Available To Work

Education & Training

Educational Background

School / Mo/Yr / Major

Employment History & Experience

List your employers, assignments or volunteer activities starting with your most recent one. please explain gaps in time in employment history.

Important: this section must be completed in detail. you may attach your resume if you wish, but reference to a resume is not a substitute for completing this section.

May We Contact This Employer?


Nature Of Work Performed/Responsibilities

Reason For Leaving

Certification & Authorization

Please read carefully before signing.

I certify that the information given herein is true and complete to the best of my knowledge. I authorize Randi’s Grill & Pub to investigate any information, including my employment history, educational background, credit history and record of criminal convictions that it believes is relevant to my employment application. My current and former employers, educational institutions, and personal references may provide information that they may have about me in response to inquiry from the employer.

I understand that any offer of employment by Randi’s Grill & Pub is contingent upon obtaining reference information learned through the above mentioned reference checks as well as upon the successful completion of a criminal history and background check.

I understand that omitting material fact and/or providing false or misleading information or misrepresentations in my application, resume, or during the interview process may result in a refusal to hire, or discharge in the event of employment.

I understand that I shall be required to provide documentation establishing my legal authorization for employment within the first three days of my employment. I understand that if employed, my employment will be at will and I will not have a guarantee of employment for any specific period of time unless otherwise provided in a written employment agreement signed by the Company President and me.

Randi’s Grill & Pub is an Equal Opportunity Employer, and shall treat all employees and all applicants for employment equally and fairly based upon job related qualifications and in accordance with all applicable local, state and federal laws.