Mex-Itali Application For Employment and Pre-Employment Questionnaire

The Mex-Itali Restaurant is an Equal Opportunity Employer. The Mex-Itali Restaurant strives to maintain a drug free workplace. Any employee found in violation will be subjected to corrective discipline up to and including termination of employment. It is understood that, as a condition of employment, anyone who is hired will be screened for illegal drugs. All employees are subject to random screening.

Personal Information

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*
Application Date:*
Name of Emergency Contact:*
Emergency Contact Phone Number:*
Are you 18 years of age or older?

Education History

Name of High School:*
Are you currently in High School?*
Name of College:
Did you graduate College?*

High Years School Completed:*
Did you Graduate High School?*
College Years Completed:
Are you currently in College?*

Military History

Have you served in the US Military?:*
Branch of the Military:
Are you a current member of the National Guard or Reserves?

Employment History

List your last three employers with the most recent first.

Are you currently employed?*

Start Date:(1)*

Start Date:(2)*

Start Date:(3*

Have you ever worked at Mex-Itali before?*
Previous Mex-Itali Employment Start Date:
If you are currently employed, may we contact your current employer?

End Date:(1)*
Reason for leaving:(1)*

End Date:(2*
Reason for leaving:(2)*

End Date:(3)*
Reason for leaving:(3)*

Referred by (if you were not referred by anyone leave this field blank):
Previous Mex-Itali Employment End Date:


Give the names of three people not related to you, whom you have known for at least one year.



Years Known:(1)*

Years Known:(2)*

Years Known:(3)*


AUTHORIZATION “I certify that 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 from 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 to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”

Type your Legal Name:*
Date Signed:*