Where are you applying to?
East                            Elkhorn
West                          Club Patrick's
Southwest                  Office West Lounge
Wet Lounge

Date:        Date you can Start:

Name:    Phone Number:

Address:    City:  State: NE IA MO KS     Zip:

Are you at least 19: Yes No    Position Applied For:     Employment: Full Time Part Time   Days Nights Day and Night

Education:
High School: Graduate: Yes No     Year

College: Graduate: Yes No Will in   Year

Honors:

Previous Employment, Most recent first:
Employer Name: City: State:  Start Date: End Date:

Manager:  Phone Number: Position:

Reason for Leaving:

Employer Name: City: State:  Start Date: End Date:

Manager:  Phone Number: Position:

Reason for Leaving:

Employer Name: City: State:  Start Date: End Date:

Manager:  Phone Number: Position:

Reason for Leaving:

Background:
Do You have a criminal Record: Yes No   If So Explain:

Please state any drug or alcohol related charges:

Is all the information on this application correct: Yes No Name: