7662 S
S. Union Parkk Ave. Midvale
e, UT 84047
P (801) 255--9800 F (801) 255-9803
Em
mail- Info@Wa
asatchbroilera
andgrill.com
www.wa
asatchbroilera
andgrill.com
Employe
ee Application
A complete ap
pplication con
nsists of this completed
c
forrm, and your ccurrent resum
me if any. Ple
ease type or p
print legibly
Today’s date
-Your date off birth ________
________-(MM/D
DD/YY)
Name as it appe
ears on your driv
ver’s license ___
______________
______________
______________
_____________
______________
___________
Last
First
Middlle
Maiden
Current address
s ____________
______________
______________
______________
______________
_____________
______________
___________
Sttreet
City
State
Z
Zip
Permanent address _________
______________
______________
______________
______________
_____________
______________
___________
Sttreet
City
State
Z
Zip
Email address
Phone Nos. with
h area code: Hom
me ___________
__________ Da
aytime ________
_____________ C
Cell __________
___________
Citizenship ____
_____________
______ If not US,, are you a perma
anent resident off the US?  Ye s  No
Are you currently authorized to work
w
in the Unite
ed States?  Yes
s  No. (Proof of eligibility will b
be required upon
n arrival.)
What position are you applying for?
f
Server Hos
stess Bartender Chef Sous Ch
hef Dishwasher Busser Manage
ement Other
Education
n
NAME OF SCHOOL
CITY
Y & STATE
YEAR
TED
COMPLET
GREE
MAJOR & DEG
High School
Undergraduate
Graduate Schoo
ol
Profes
ssional Exp
perience
Current or mostt recent employer
Supervissor
Employm
ment dates
Name _
______________
___________
From ____
________
Phone _
______________
___________
To
Briefly describe your title and du
uties:
Briefly describe any experience in the restaurantt industry:
Briefly describe any experience in supervising or management:
Wasatc
ch Broiler & Grill
G
Employee
e Application 2
2012
____
________
Criminal Record
Have you ever been convicted of a crime, other than traffic violations?  Yes  No
If yes, explain nature and location of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s)
imposed, and type(s) of rehabilitation. __________________________________________________________________________________
________________________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Driving Record (For Delivivery Drivers Only)
Driver’s license number ___________________________ State of issue _______ Expiration date _____________________
Have you had any vehicle accidents during the past three years in which you were at fault?  Yes  No
If so, describe the causes, damages, and any injuries to yourself or others
____________________________________________________________________________________________________
____________________________________________________________________________________________________
References
List two professional references, people with whom you have worked preferably present or former supervisors.
Name ______________________________________________
Name _______________________________________________
Relationship _________________________________________
Relationship
Position ____________________________________________
Position ____________________________________________
Employer ___________________________________________
Employer ____________________________________________
Address ____________________________________________
Address ____________________________________________
___________________________________________________
___________________________________________________
Phone
Email
___________________________________________
_____________________________________________
_________________________________________
Phone _____________________________________________
Email
_____________________________________________
Consent Agreement and Publicity Release
In consideration of my prospective employment by Wasatch Broiler & Grill.:
I authorize investigation of all statements contained in this form, including my criminal record and driving record. I
understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any
previous notice. I hereby give Wasatch Broiler & Grill permission to contact my previous or current schools or employers,
references, and others, and hereby release Wasatch Broiler & Grill from any liability as a result of such contact.
Signature __________________________________________ Date: ___________________
Wasatch Broiler & Grill is an equal opportunity employer. We adhere to a policy of making employment decisions without
regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability.
Employee Application
A complete application consists of this completed form, and your current resume if any. Please type or print legibly
Wasatch Broiler & Grill Employee Application 2012
Today’s date
-Your date of birth _______________-(MM/DD/YY)
Name as it appears on your driver’s license _____________________________________________________________________________
Last
First
Middle
Maiden
Current address ___________________________________________________________________________________________________
Street
City
State
Zip
Permanent address ________________________________________________________________________________________________
Street
City
State
Zip
Email address
Phone Nos. with area code: Home ____________________ Daytime ____________________ Cell ____________________
Citizenship _____________________ If not US, are you a permanent resident of the US?  Yes  No
Are you currently authorized to work in the United States?  Yes  No. (Proof of eligibility will be required upon arrival.)
What position are you applying for? Server Hostess Bartender Chef Sous Chef Dishwasher Busser Management Other
Education
NAME OF SCHOOL
CITY & STATE
YEAR
COMPLETED
MAJOR & DEGREE
High School
Undergraduate
Graduate School
Professional Experience
Current or most recent employer
Supervisor
Employment dates
Name ________________________
From ___________
Phone ________________________
To
___________
Briefly describe your title and duties:
Briefly describe any experience in the restaurant industry:
Briefly describe any experience in supervising or management:
Criminal Record
Have you ever been convicted of a crime, other than traffic violations?  Yes  No
If yes, explain nature and location of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s)
imposed, and type(s) of rehabilitation. __________________________________________________________________________________
________________________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Wasatch Broiler & Grill Employee Application 2012
Driving Record (For Delivivery Drivers Only)
Driver’s license number ___________________________ State of issue _______ Expiration date _____________________
Have you had any vehicle accidents during the past three years in which you were at fault?  Yes  No
If so, describe the causes, damages, and any injuries to yourself or others
____________________________________________________________________________________________________
____________________________________________________________________________________________________
References
List two professional references, people with whom you have worked preferably present or former supervisors.
Name ______________________________________________
Name _______________________________________________
Relationship _________________________________________
Relationship
Position ____________________________________________
Position ____________________________________________
Employer ___________________________________________
Employer ____________________________________________
Address ____________________________________________
Address ____________________________________________
___________________________________________________
___________________________________________________
Phone
Email
___________________________________________
_____________________________________________
_________________________________________
Phone _____________________________________________
Email
_____________________________________________
Consent Agreement and Publicity Release
In consideration of my prospective employment by Wasatch Broiler & Grill.:
I authorize investigation of all statements contained in this form, including my criminal record and driving record. I
understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any
previous notice. I hereby give Wasatch Broiler & Grill permission to contact my previous or current schools or employers,
references, and others, and hereby release Wasatch Broiler & Grill from any liability as a result of such contact.
Signature __________________________________________ Date: ___________________
Wasatch Broiler & Grill is an equal opportunity employer. We adhere to a policy of making employment decisions without
regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability.
Employee Application
A complete application consists of this completed form, and your current resume if any. Please type or print legibly
Today’s date
-Your date of birth _______________-(MM/DD/YY)
Name as it appears on your driver’s license _____________________________________________________________________________
Last
First
Middle
Maiden
Current address ___________________________________________________________________________________________________
Street
City
State
Zip
Permanent address ________________________________________________________________________________________________
Street
City
State
Zip
Email address
Phone Nos. with area code: Home ____________________ Daytime ____________________ Cell ____________________
Wasatch Broiler & Grill Employee Application 2012
Citizenship _____________________ If not US, are you a permanent resident of the US?  Yes  No
Are you currently authorized to work in the United States?  Yes  No. (Proof of eligibility will be required upon arrival.)
What position are you applying for? Server Hostess Bartender Chef Sous Chef Dishwasher Busser Management Other
Education
NAME OF SCHOOL
CITY & STATE
YEAR
COMPLETED
MAJOR & DEGREE
High School
Undergraduate
Graduate School
Professional Experience
Current or most recent employer
Supervisor
Employment dates
Name ________________________
From ___________
Phone ________________________
To
___________
Briefly describe your title and duties:
Briefly describe any experience in the restaurant industry:
Briefly describe any experience in supervising or management:
Criminal Record
Have you ever been convicted of a crime, other than traffic violations?  Yes  No
If yes, explain nature and location of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s)
imposed, and type(s) of rehabilitation. __________________________________________________________________________________
________________________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Driving Record (For Delivivery Drivers Only)
Driver’s license number ___________________________ State of issue _______ Expiration date _____________________
Have you had any vehicle accidents during the past three years in which you were at fault?  Yes  No
If so, describe the causes, damages, and any injuries to yourself or others
____________________________________________________________________________________________________
____________________________________________________________________________________________________
References
Wasatch Broiler & Grill Employee Application 2012
List two professional references, people with whom you have worked preferably present or former supervisors.
Name ______________________________________________
Name _______________________________________________
Relationship _________________________________________
Relationship
Position ____________________________________________
Position ____________________________________________
Employer ___________________________________________
Employer ____________________________________________
Address ____________________________________________
Address ____________________________________________
___________________________________________________
___________________________________________________
Phone
Email
___________________________________________
_____________________________________________
_________________________________________
Phone _____________________________________________
Email
_____________________________________________
Consent Agreement and Publicity Release
In consideration of my prospective employment by Wasatch Broiler & Grill.:
I authorize investigation of all statements contained in this form, including my criminal record and driving record. I
understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any
previous notice. I hereby give Wasatch Broiler & Grill permission to contact my previous or current schools or employers,
references, and others, and hereby release Wasatch Broiler & Grill from any liability as a result of such contact.
Signature __________________________________________ Date: ___________________
Wasatch Broiler & Grill is an equal opportunity employer. We adhere to a policy of making employment decisions without
regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability.
Employee Application
A complete application consists of this completed form, and your current resume if any. Please type or print legibly
Today’s date
-Your date of birth _______________-(MM/DD/YY)
Name as it appears on your driver’s license _____________________________________________________________________________
Last
First
Middle
Maiden
Current address ___________________________________________________________________________________________________
Street
City
State
Zip
Permanent address ________________________________________________________________________________________________
Street
City
State
Zip
Email address
Phone Nos. with area code: Home ____________________ Daytime ____________________ Cell ____________________
Citizenship _____________________ If not US, are you a permanent resident of the US?  Yes  No
Are you currently authorized to work in the United States?  Yes  No. (Proof of eligibility will be required upon arrival.)
What position are you applying for? Server Hostess Bartender Chef Sous Chef Dishwasher Busser Management Other
Education
NAME OF SCHOOL
CITY & STATE
YEAR
COMPLETED
High School
Wasatch Broiler & Grill Employee Application 2012
MAJOR & DEGREE
Undergraduate
Graduate School
Professional Experience
Current or most recent employer
Supervisor
Employment dates
Name ________________________
From ___________
Phone ________________________
To
___________
Briefly describe your title and duties:
Briefly describe any experience in the restaurant industry:
Briefly describe any experience in supervising or management:
Criminal Record
Have you ever been convicted of a crime, other than traffic violations?  Yes  No
If yes, explain nature and location of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s)
imposed, and type(s) of rehabilitation. __________________________________________________________________________________
________________________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Driving Record (For Delivivery Drivers Only)
Driver’s license number ___________________________ State of issue _______ Expiration date _____________________
Have you had any vehicle accidents during the past three years in which you were at fault?  Yes  No
If so, describe the causes, damages, and any injuries to yourself or others
____________________________________________________________________________________________________
____________________________________________________________________________________________________
References
List two professional references, people with whom you have worked preferably present or former supervisors.
Name ______________________________________________
Name _______________________________________________
Relationship _________________________________________
Relationship
Position ____________________________________________
Position ____________________________________________
Employer ___________________________________________
Employer ____________________________________________
Address ____________________________________________
Address ____________________________________________
___________________________________________________
___________________________________________________
_________________________________________
Wasatch Broiler & Grill Employee Application 2012
Phone
Email
___________________________________________
_____________________________________________
Phone _____________________________________________
Email
_____________________________________________
Consent Agreement and Publicity Release
In consideration of my prospective employment by Wasatch Broiler & Grill.:
I authorize investigation of all statements contained in this form, including my criminal record and driving record. I
understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any
previous notice. I hereby give Wasatch Broiler & Grill permission to contact my previous or current schools or employers,
references, and others, and hereby release Wasatch Broiler & Grill from any liability as a result of such contact.
Signature __________________________________________ Date: ___________________
Wasatch Broiler & Grill is an equal opportunity employer. We adhere to a policy of making employment decisions without
regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability.
Wasatch Broiler & Grill Employee Application 2012