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1412 W Broad St • Waynesboro, VA 22980
(540) 942-8715

call us

(540) 942-8715

our address

1412 W Broad St
Waynesboro, VA 22980

our hours

Sunday
11:30am-9pm
Monday-Tuesday
11am-9pm
Wednesday-Thursday
11am-9:30pm
Friday-Saturday
11am-9pm.

Employment Application

If you are interested in joining our team please fill out the below employment application.
Thank you for your interest. We will get back to you as soon as we can. 

First Name(*):
Middle Name(*):
Last Name(*):
Email(*):
City(*):
State(*):
Zip(*):
Phone(*):
Are you 18 or older(*):
 Yes
 No
Do you have transportation(*):
 Yes
 No
Currently employed(*):
 Yes
 No
Date you can start(*):
Desired position(*):
Desired pay rate/salary:
Hours/days available(*):
Desired hours per week(*):

Have you been convicted of a crime or had a diversion in the last 7 years:

Make selection(*):
 Yes
 No
If yes, nature of offense:
Have you worked for us before:
 Yes
 No
if yes, list dates and reason:

EDUCATION

High School and City(*):
Grade Completed(*):
Graduation Date:
College Name and City:
School Achievements:
List activities or hobbies:

EMPLOYMENT HISTORY

Most recent employer.

Employer name:
Starting wage:
Ending wage:
Start date:
End date:
Reason for leaving:
Type of business:
Position held:
Eligible for rehire:
 Yes
 No
Supervisior name:
Employer phone number:
May we contact:
 Yes
 No

Previous employer

Employer name (2):
Starting wage (2):
Ending wage (2):
Starting date (2):
Ending date (2):
Reason for leaving (2):
Type of business (2):
Position held (2):
Eligible for rehire (2):
 Yes
 No
Supervisor name (2):
May we contact (2):
 Yes
 No

REFERENCES

List three personal or professional references that we may contact:

Reference #1

Name(*):
Relationship to you(*):
Number of years known(*):
Reference phone:
Reference email:

Reference #2

Name (2):
Relationship to you (2):
Number of years known (2):
Reference phone (2):
Reference email (2):

Reference #3

Name (3):
Relationship to you (3):
Number of years known (3):
Reference phone (3):
Reference email (3):

Please make sure you answered all the required (*) questions before you submit.

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