CONTACT US LOCATION 4317 Linden Ave.Dayton, OH, 45432 PHONE (937) 938-1343 HOURS Sunday: 11:00 AM - 12:00 AM Monday - Thursday 12:00 PM - 12:00 AM Friday & Saturday 12:00 PM - 1:00 AM Employment Application Step 1 of 4 - Applicant Information 25% APPLICANT INFORMATIONName First M.I. Last Date Address City State ZIP Code PhoneEmail Position Applied for Are You a Citizen of the United States? Yes No If no, are you authorized to work in the U.S.? Yes No Have you ever worked for this company? Yes No If yes, when? Have you ever been convicted of a felony? Yes No If yes, explain: EDUCATIONHigh School Address From To Did you graduate? Yes No Diploma College Address From To Did you graduate? Yes No Diploma Other Address From To Did you graduate? Yes No Diploma REFERENCESPlease list three professional references.Full Name Relationship Company Phone Address Full Name Relationship Company Phone Address Full Name Relationship Company Phone Address PREVIOUS EMPLOYMENTCompany Phone Address Supervisor Job Title Starting Salary Ending Salary ResponsibilitiesFrom To Reason for Leaving May we contact your previous supervisor for reference? Yes No Company Phone Address Supervisor Job Title Starting Salary Ending Salary ResponsibilitiesFrom To Reason for Leaving May we contact your previous supervisor for reference? Yes No Company Phone Address Supervisor Job Title Starting Salary Ending Salary ResponsibilitiesFrom To Reason for Leaving May we contact your previous supervisor for reference? Yes No CONFIRMATION & SIGNATUREI certify that my answers are true and complete to the best of me knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.Signature Date CAPTCHANameThis field is for validation purposes and should be left unchanged.