EMPLOYMENT APPLICATION We are an E-Verify employer. ~ APPLY BY FILLING OUT THE FORM BELOW ~ All required fields are indicated with an * Name* First Last Date* Date Format: MM slash DD slash YYYY Phone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Who were you referred by?Location Where You'd Like To Apply*Cranberry, PAColumbus (Airport), OHColumbus (On The Boulevard), OHDayton (Airport), OHDetroit (Airport), MIEdinburgh, INErie, PAHebron - Cincinnati (Airport), KYLancaster, OHMaumee, OHMiddleburg Heights, OHMonroeville, PANorfolk (Doubletree Hotel), VAReynoldsburg (East Broad), OHVirginia Beach (Doubletree Hotel), VAWilmington, OHHave you worked for Glacier Restaurant Group before?*(please mark all that apply) Craggy Range Ciao Mambo Latitude 48 MacKenzie River Max & Erma's I have not worked for Glacier Restaurant Group in the past. What position are you applying for?*(please mark all that apply) Host Bus Server Kitchen Dish Bar Mangement Date available to start working with us:* Date Format: MM slash DD slash YYYY Are you under 18?* Yes No Are you legally eligible for employment in this country?* Yes No How many shifts per week would you like to work?*Availability*(please mark all that apply) Sunday - day Sunday - night Monday - day Monday - night Tuesday - day Tuesday - night Wednesday - day Wednesday - night Thursday - day Thursday - night Friday - day Friday - night Saturday - day Saturday - night What current or future obligations affect your ability to work (other commitments, another job, school, sports, vacations, etc)?*May we contact your current employer?* Yes No Not Currently Employed Please list your latest three employers (most recent first). Do not write “see resume.”*Please list: Employer, Contact Name, Phone Number, Position Held, Dates of Employment & Reason for Leaving for each EmployerApplicant Declaration & Signature*Applicant Declaration (Type in Your Name)* I expressly authorize Max & Erma's and/or its representatives to contact my previous employers or other persons to verify and obtain any information concerning me. I certify that the information I have provided is true. I understand that providing misleading or false information may exclude me from hire, or if hired, may result in my discharge. I understand that completion of this application does not guarantee an interview or employment. I understand that Max & Erma's is an Equal Opportunity Employer, and that the information contained in this application will not be used to discriminate against me on any basis prohibited by law. Max & Erma's is an E-Verify employer.