Employment Application

In compliance with Federal and State equal employment opportunity laws, it is this company's intention to consider all applicants without regard to race, color, religion, sex, national origin, age, marital status, disability, the presence of non-job related medical conditions or any other protected classification

( * ) Indicates Mandatory Field.

Job Position

Social Security *

Name *


First Name	Middle Name	Last Name

Address *

City * State * Zip *

Phone *

Date of birth
Positions required to serve alcohol must be 18 years of age or older

Are you authorized to work in the United States?

Date able to start * Pay Expected

Are you available for full time work?

Are you available to work? Mornings Evenings Sundays Nights

High school attended Did you graduate?

College attended Years completed

Major/Minor Did you graduate?

Special abilities or Knowledge related to the job
Note : Please do not list those items which are related to race, sex, religion, color, national origin, age, marital status, disability or non-job related medical conditions

Other experiences, skills or abilities

Employment Experience (start with the most recent)

1	Name of company Name of Supervisor Dates of employment to Phone Salary Job Title Reason for Leaving

2	Name of company Name of Supervisor Dates of employment to Phone Salary Job Title Reason for Leaving

3	Name of company Name of Supervisor Dates of employment to Phone Salary Job Title Reason for Leaving

REFERRAL SOURCE: Advertisement Employee Relative Government Employment Agency Walk-in Other

Do you have a relative working for Cosimos?

References

Name	Phone	Years known

General Information

In case of emergency, please notify?

Name * Phone *

Address *

Will you abide by the safety rules of this company? *

Have you ever been convicted of a felony, pled guilty to a felony, or been placed on probation for a felony offense?
(Conviction will not necessarily disqualify an applicant for employment.)

Date	Nature of Conviction	Where	Disposition of Offense

Have you ever been previously employed by:

Cosimo Trattoria & Bar Cosimos on Union Cosimos Brick Oven Torches on the Hudson Other CRG Restaurants

If so, when? to

Where? Reason for leaving

PLEASE READ THE FOLLOWING CAREFULLY

I declare that I am qualified and physically able to perform all the duties of the position I am seeking. I also declare that the information I have provided on this application is correct, and that any false statements or omis-sions will justify my rejection or dismissal. I authorize the company to contact any of my previous employers as well as any reference source to verify the facts and information I have furnished regarding my qualifications and character. I authorize any person(s) having knowledge to provide such information to the company, and release from liability and agree to hold harmless any person that furnishes such information in good faith. I will agree to a drug test, if permitted by law, to be paid for by the company. Should I become involved in a claim for worker 's compensation or any other litigation after employment by the company, I will allow the company to supply my employment records to an opposing party. If employed by the company, I understand that I will be an employee at will, and that my employment with Cosimo 's Management or any of its subsidiaries or affiliates (collectively, 'Cosimo 's'), may be terminated at anytime by myself or Cosimo 's for any reason whatsoever. I further under- stand that if employed by Cosimo 's no representative of Cosimo 's, other than the Chief Executive Officer or his or her designee, has any authority to modify or change my status as an employee at will, and that any such modi- fication must be in writing. Finally, I understand that this is only an application for employment and neither an offer of or contract of employment and no part of this application shall be construed as an offer of employment or an employment contract.

I accept the Terms of Employment. *