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Are you 18 years of age or older? Yes No

Are you eligible for employment?
(Proof of Citizenship or Immigration Status will be required upon employment) Yes No

Which location are you applying for? select one Burlington Grafton Oak Creek West Bend Racine East Racine West Festivals

Have you ever been employed by the Charcoal Grill? Yes No

What hours are you available to work:

EMPLOYMENT HISTORY (List in order, last or present employer first.)

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Salary/Wage

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Salary/Wage

May we contact your present or former employers? Yes No

By submitting this form, I understand and agree that:

1. Employers for whom I have worked in the past may be requested to furnish the Charcoal Grill information concerning my past employment or activities and I hereby release such employers from liability in connection therewith.

2. Any false statement, omission or misrepresentation made in conjunction with my past record or any other part of my application for employment with the Charcoal Grill will be justification, should I be employed, for my dismissal regardless of when such facts may be discovered