BURRACHOS FRESH MEXICAN GRILL

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Personal Information

First Name:

Middle Name:

Last Name:

Current Address

Street: City: State: Zip:

From Date:

To Date:

Phone

Daytime Phone:

Evening Phone:

E-mail:*

History With Burrachos

Have you ever worked for this Company? Yes No If yes, where?:

Dates of Employment: From: To: Reason for Leaving:

Employment Interests

Location You Are Applying To:

Position You Are Applying For:

Date You Can Start:

Total Number of Hours Desired Per Week:

Expected Wage:

Type of Employment Desired (Please Select Below):

Full Time: Part Time: Temporary Temp Dates: From: To:

Days and Times Available (indicate a.m. and / or p.m.)

Describe any extracurricular activities, clubs, hobbies, etc.

General Information

Are you 18 years of age or older? Yes No

Do you have access to a reliable form of transportation? Yes No If Yes, what type?

If employment is offered, can you submit verification of your legal right to work in the United States?

Yes No

BURRACHOS