EmailMe Form - Grizzly's Employment Application

Please select the Grizzly's location you are applying to: *

Baxter

Eau Claire

Waite Park

Willmar

Personal Information

Name *

First Last

Email *

Present Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Permanent Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Referred By

Employment Desired

Position

Date You Can Start

MM / DD / YYYY

Wage Desired

Availability

Are you currently employed?

Yes

No

Check all that apply:

Days 8am-4pm

Nights 4pm-Close

Weekends

Desired Hours Per Week

Is there any time during the year you would not be available?

Yes

No

If Yes, please explain

Education History

High School

College/Tech School

Military

U.S. Military Service

Yes

No

Branch

Rank

Employment History

Please list your last three employers, starting with the last one first.

Employer #1 Name, City, State

Employer #1 Work Dates

Employer #1 Position

Employer #1 Reason for Leaving

Employer #2 Name, City, State

Employer #2 Work Dates

Employer #2 Position

Employer #2 Reason for Leaving

Employer #3 Name, City, State

Employer #3 Work Dates

Employer #3 Position

Employer #3 Reason for Leaving

I certify the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company for all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or make any arrangement contrary to the foregoing unless it is in writing and signed by an authorized company representative.

Grizzly's is an equal opportunity employer.

Signature *

Clear