Minnesota Breakfast & Pancakes - Original Pancake House

Personal Information

Name *

First Last

Address *

City *

State, Zip Code *

Phone Number *

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

Are you eligible to work in the United States? *

Yes

No

If you are under age 18, do you have an employment/age certificate? *

Yes

No

If yes, please explain:

Have you ever been convicted of a felony? If yes, please explain: *

Yes

No

If yes, please explain:

POSITION/AVAILABILITY:

Store Applied For (Edina, Eden Prairie, or Both) *

Position Applied For *

Days Available *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Any

What date are you available to start work? *

MM / DD / YYYY

EDUCATION:

Name and Address Of School - Degree/Diploma - Graduation Date

Skills and Qualifications: Licenses, Skills, Training, Awards

EMPLOYMENT HISTORY:

Present Or Last Position:

Employer:

Address:

Supervisor:

Phone Number

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

Email

Position Title:

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Responsibilities:

Salary

Input hourly wage, if not salaried.

Reason for Leaving:

May We Contact This Employer?

Yes

No

Previous Position

Employer:

Address:

Supervisor:

Phone Number

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

Email

Position Title:

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Responsibilities:

Salary

Input hourly wage, if not salaried.

Reason for Leaving:

May We Contact This Employer?

Yes

No

Previous Position

Employer:

Address:

Supervisor:

Phone Number

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

Email

Position Title:

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Responsibilities:

Salary

Input hourly wage, if not salaried.

Reason for Leaving:

May We Contact This Employer?

Yes

No

References:
Name/Title Address Phone

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Do you agree with the terms and conditions? *

Yes, I agree.

Initial *

Date *

MM / DD / YYYY

The Original Pancake House

Personal Information

POSITION/AVAILABILITY:

EDUCATION:

EMPLOYMENT HISTORY: