Personal Data
First Name:
Last Name:
Middle Initial :
Internet E-mail:
Telephone Number:
Mobile Number:
Address:
City:
State:
Zip:
Employment Information
Position(s) Applied For:
Salary Desired?:
Soc. Security #:
Are you 18 years of age or over?:	Yes:    No:
If not, what is your age?:
Are you legally authorized to work in the United States?:	Yes:    No:
Have you ever been employed by or previously applied to Louie's Oyster Bar & Grille or any of its subsidiaries? If so, please check the appropriate box and specify location(s) and date(s).
How were you referred to Louie's Oyster Bar & Grille?:
Can you carry 50 pounds a distance of 50 feet with or without reasonable accommodation?:	Yes:    No:
The following conditions may be required as part of a job assignment. If required, would you be willing to work:
A. Shift work?:	Yes:    No:
B. Rotational work schedule?:	Yes:    No:
C. Work schedule other than Monday thru Friday?:	Yes:    No:
D. Overtime work?:	Yes:    No:
When could you be available to begin work?:
Type of employment desired:	Regular: Part-Time: Temporary: Summer: Cooperative Education:
Education And Training
Did you graduate high school?:	Yes:    No:
What high school?:
Did you graduate college?:	Yes:    No:
If so, what college?:
Please list all Degrees, Diplomas, Certificates, Majors, Minors, and Fields of Study:
Security Data
Have you ever been convicted of a felony?:	Yes:    No:
If yes, please briefly describe the circumstances of your conviction, indicating the date, nature, and place of the offense and disposition of the case. A conviction will not necessarily disqualify an applicant from employment since this will be looked upon as only one of the factors considered in the employment decision and is evaluated in terms of the nature, severity, and date of the offense.
Employment Experience
Please list your last four employers. Start with your present status and note any periods in which you were not employed. Include U.S. military service, previous Louie's Oyster Bar & Grille experience, summer/part-time jobs, and cooperative education assignments.

Employer:
Address:
Phone:
Start Date:
Termination Date:
Starting Salary:
Ending Salary:
Position, Title, and Description of Duties:
Reason for Leaving:
Employment History - Position 2

Employer:
Address:
Phone:
Start Date:
Termination Date:
Starting Salary:
Ending Salary:
Position, Title, and Description of Duties:
Reason for Leaving:
Employment History - Position 3

Employer:
Address:
Phone:
Start Date:
Termination Date:
Starting Salary:
Ending Salary:
Position, Title, and Description of Duties:
Reason for Leaving:
Employment History - Position 4
Employer:
Address:
Phone:
Start Date:
Termination Date:
Starting Salary:
Ending Salary:
Position, Title, and Description of Duties:
Reason for Leaving:
Do you have any objections to our contacting your present employer to verify the above?
No, you may not contact anytime. Do not contact now, you may contact at a later date.
Please specify: contact after acceptance of offer    Other

Please Read The Following Statement Carefully The information that I have provided on this application is accurate to my best knowledge and subject to verification by Louie's Oyster Bar & Grille. I authorize the persons, schools, current employer (if approved by me in Employment Experience section) and other organizations or employers named in this application to provide Louie's Oyster Bar & Grille with any relevant information or school transcript information that may be required to make an employment decision. I understand and agree that: Any misrepresentation or omission of a fact in my application may be justification for refusal of, or if employed, termination from employment. Although management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory: overtime, shift work, a rotating work schedule, or a work schedule other than Monday through Friday. I understand and accept these conditions of my continuing employment. If my application for employment is accepted, the effective date of my employment shall be the time I actually begin work. If I am employed, I agree to comply with, and be bound by, the safety and health rules of conduct of Louie's Oyster Bar & Grille together with the obligations set forth in Louie's Oyster Bar & Grille's Non-Compete/Non-Disclosure Agreement, if applicable. I understand that nothing contained in this application, or in granting an interview is intended to create a contract for either employment or providing of any benefit. If employed by Louie's Oyster Bar & Grille, I understand that my employment is at will, and is not guaranteed for any term; my employment may be terminated by Louie's Oyster Bar & Grille or myself at any time, or for any reason with or without cause or notice. Only the Chief Executive Officer of Louie's Oyster Bar & Grille is authorized to make a promise of continuing employment for a specific term and any such agreement may only be made only in writing and cannot be made orally.

This application Will Receive Active Consideration for Thirty Days.
*Louie's Oyster Bar & Grille does not discriminate in hiring or employment on the basis of race, color, religion, national origin, sex, age, disability or veteran status. No question on this application is intended to secure information to be used for such discrimination.