Personal Information * First Name : * Last Name : * Email : Address : Address 2 : City : State : [ ..:::Select:::.. ] Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Armed Forces Pacific Zip : Phone Number : Alternate Phone : Position Desired ................SELECT................. Porter Barback Security Go-Go Managers Bartenders DJ's Door Girls Cocktails Are you over the age of 18 : Yes No Are you over the age of 21 : Yes No Availability Information Date available to start : List any days or times you are not available to work : Do you have plans that would require time off in the next six months : Yes No Full/Part Time/Either : Education and Experience Highest Degree Obtained : Years of Experience in the Club / Bar / Restaurant Industry : How many years of experience have you had with a Night Club : Employment Information Current Annual Salary/Wage: Desired Rate of Pay : Previous Employers Company Name : Supervisor’s Name : Job Title : Start Date (YYYY-MM-DD) : End Date (YYYY-MM-DD) : Reason for leaving : Phone Number : May we contact his employer: Yes No Company Name : Supervisor’s Name : Job Title : Start Date (YYYY-MM-DD) : End Date (YYYY-MM-DD) : Reason for leaving : Phone Number : May we contact his employer: Yes No Company Name : Supervisor’s Name : Job Title : Start Date (YYYY-MM-DD) : End Date (YYYY-MM-DD) : Reason for leaving : Phone Number : May we contact his employer: Yes No Professional References Reference 1   Name : Occupation: Company : Address : Phone (xxx) xxx-xxxx : Email : Reference 2   Name : Occupation: Company : Address : Phone (xxx) xxx-xxxx : Email : Reference 3   Name : Occupation: Company : Address : Phone (xxx) xxx-xxxx : Email : Additional Information Are you currently employed : Yes No Have you ever been convicted of a felony or plead no contest to a felony charge : Yes No Are you legally authorized to work in the US : Yes No Can you perform the essential functions of the job for which you are applying : Yes No Why are you interested in an opportunity with Zouk : Please provide the top three reasons you have chosen the Nightclub industry as a career : Attachment Resume Attachment Resume :     Enter the above code : * I agree to comply with all the rules of this Company. I certify that all the foregoing statements are true and correct, and that I have not knowingly withheld any fact that would, if disclosed, affect my application unfavorably. I 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 listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.