* Mandatory Fields PERSONAL DETAILS * Store Location Select Location Avon Marketplace Bushnells Basin Empire Newark Greece Canandaigua Eastview Fairport   * Last Name   * First Name       Address       City       Zip Code     * Phone Number     * Email Address       If your age is below 18 years, what is your date of birth?   Date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December     If your age is below 18 years, Do you have a work permit?   Yes No     Relatives or friends working at Tom Wahl's?   Yes No     If yes, give their names       Have you ever been convicted of a crime?   Yes No     If yes, please describe the conviction, your age at the time of the offense and your rehabilitation since the conviction. A conviction record will not necessarily bar your chances of employment.       Have you ever worked for Tom Wahl's, Bill Gray's or Hegedorns before?   Yes No     If yes, give dates       If you are a student, what is your school name?       Grade or Year Currently in or completed.       Activities, hobbies, interests       Date you can start working   Date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021     Are you interested in working   Full Time Part Time     List any Times you are not available to work (include time attending school, any school activities, other jobs, etc.)       WORK EXPERIENCE     Please list your prior jobs (If Applicable) starting with the most recent     1. Employer     Supervisor       Dates of Employment   To Type of work       Reason for Leaving                     2. Employer     Supervisor       Dates of Employment   To Type of work       Reason for Leaving                     3. Employer     Supervisor       Dates of Employment   To Type of work       Reason for Leaving                   I certify that the information contained on this application is correct to the best of my knowledge and understand that deliberate falsification of this information is grounds for dismissal in accordance with the policy of Tom Wahl's Restaurants. I acknowledge that if I become employed, I will be free to terminate my employment at any time for any reason and Tom Wahl's retains the same rights.