The Dakota Restaurant Group

I. Personal Information

First Name:    Last Name:    Middle Initial:

Address:

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver's license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

Position Applied For:

Do you have any relatives who are presently (or have formerly been) employed by The Dakota Group?

How were you referred to The Dakota Group?

Have you ever been convicted of a felony?
Yes   No

If yes, please explain:

II. Educational History

Elem/ Jr. High

School Name/Location:

Years Completed:    Degree/Diploma:

High School

School Name/Location:

Years Completed:    Degree/Diploma:

College

School Name/Location:

Years Completed:    Degree/Diploma:

Other

School Name/Location:

Years Completed:    Degree/Diploma:

III. Work Availibility

If your application receives favorable consideration, when will you be able to begin work?

Do you have any objection to working overtime?
Yes   No

Can you work overtime without prior notice?
Yes   No

Can you work on Saturday?
Yes   No

Can you work on Sunday?
Yes   No

Can you travel if required by this position?
Yes   No

IV. Salary / Hourly Rate Requirements

If your application receives favorable consideration, what salary/hourly rate would you require?

V. Employment Record   Please start with your most recent employer

(Current or most Recent Employer)

1. Company Name:    Positon Held:

Supervisor/Manager:    Dates Employed:

Reason for leaving:    Telephone:    Wage/Salary:

May we contact this employer?
Yes   No    Reason:

2. Company Name:    Positon Held:

Supervisor/Manager:    Dates Employed:

Reason for leaving:    Telephone:    Wage/Salary:

May we contact this employer?
Yes   No    Reason:

3. Company Name:    Positon Held:

Supervisor/Manager:    Dates Employed:

Reason for leaving:    Telephone:    Wage/Salary:

May we contact this employer?
Yes   No    Reason:

VI. References   Please do not include relatives or former employers.

1. Name:    Years Known:

Address:    Telephone:

Occupation:

2. Name:    Years Known:

Address:    Telephone:

Occupation:

3. Name:    Years Known:

Address:    Telephone:

Occupation: