Application For Employment:

Last Name________________________________  First Name__________________________ Middle_____

Address________________________________________________________________________________

Telephone #_________________________________ 2nd #_______________________________________

Soc. Security #____________________________________  EIC:__________________________________

Marital Status________________________________  # Dependants______________________

Position Desired:_________________________________________________________________________

Experience______________________________________________________________________________

Shift Preference:  Full Time_______     Part Time_______

Any Hours You Can't Work:___________________________________  Reason_______________________

Date You Can Start:____________________ 

Are You Currently Employed:_______________  Where:_________________________________________

Birthdate (Optional):______________________  Current Hours Employed___________________________

Last 3 Employers, Starting with Last Job:

COMPANY:                                                     POSITION:                                                 REASON FOR LEAVING..

________________________________      _______________________________     ____________________

________________________________      _______________________________     ____________________

________________________________      _______________________________     ____________________

Comments:_______________________________________________________________________________

REFERENCES: (Unrelated people that you have known for at least 1 year we may contact.)

   Name                                                                  Company/How you Know                 Phone:

1. ____________________________________  ____________________________  _____________________

2. ____________________________________  ____________________________  _____________________

3. ____________________________________  ____________________________  _____________________

Interviewed By:___________________________________ Date__________________

Comments:_______________________________________________________________________________

 Please Drop Off At:     Fisherman's Cove - N9176 Hwy 151 - Fond du Lac, WI 54935

OR    Perl's Country Inn - W3675 Hwy 149 - Malone, WI 53049

OR   JUST FAX BACK TO:   (920) 273-6161  for faster review!!!!!