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Application for Employment
Step
1
of
5
20%
Name
(Required)
First
Last
Email
(Required)
Current Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Permanent Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone (mobile)
Are you under 18 years of age?
(Required)
Yes
No
Birth Date
(Required)
MM slash DD slash YYYY
Are you eligible to work in the United States?
(Required)
Yes
No
Have you worked at any of our sister companies?
(Required)
Yes
No
(Duluth Grill, OMC Smokehouse, Corktown Deli & Brews, Burger Paradox, Goat Hill Marketplace, or Minnesconsin Merch)
Describe your relevant work experience
If hired, do you have reliable transportation to and from the location you are applying to?
(Required)
Yes
No
Explain your transportation capabilities:
(Required)
Emergency Contact
(Required)
First
Last
Emergency Contact Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Emergency Contact Phone
(Required)
Are you a military veteran?
Yes
No
Education
High School or GED completed?
(Required)
Yes
No
Employment Desired
Position(s) Applying for
(Required)
Prep Cook
Line Cook
Server
Bartender
Host/Busser
Utility/Dishwasher
What type of position are you applying for?
(Required)
Part Time
Full Time
Date Available
(Required)
MM slash DD slash YYYY
Rate of Pay Desired
Availability
(Required)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday Hours Available
Tuesday Hours Available
Wednesday Hours Available
Thursday Hours Available
Friday Hours Available
Saturday Hours Available
Sunday Hours Available
Employment History
Employer #1 Name & Location
Employer #1 Date Hired
MM slash DD slash YYYY
Employer #1 Date Ended
MM slash DD slash YYYY
Employer #1 Job Duties
Reason for Leaving Employer #1
May we contact employer #1?
Yes
No
Employer #2 Name & Location
Employer #2 Date Hired
MM slash DD slash YYYY
Employer #2 Date Ended
MM slash DD slash YYYY
Employer #2 Job Duties
Reason for Leaving Employer #2
May we contact employer #2?
Yes
No
References
List persons not related to you as references, whom you have known for at least one year.
Reference #1 Name
First
Last
Reference #1 Phone
Reference #1 Years Acquainted
Reference #1 Relationship
Personal
Business
Reference #2 Name
First
Last
Reference #2 Phone
Reference #2 Years Acquainted
Reference #2 Relationship
Personal
Business
Additional References (if any)
Are you known to schools/references by another name?
Yes
No
Other Name
First
Last
Agree to Terms Before Submitting Application
1. I authorize investigation of all statements contained on this application except where I have requested on this form that no investigation be made. 2. I understand that misrepresentation or omission of facts called for is cause for dismissal and that my employment is substantially dependent on truthful answers to the fore going inquires. 3. I understand that nothing contained in this employment application or in the granting of an interview is intended to nor does it create an employment contract between the company and myself for either employment or the providing of any benefit. In the event that an employment relationship is established, I understand that I have the right to terminate my employment at any time for any reason, and the company retains the same right regarding the discontinuation of my employment.
Authorization
(Required)
I understand and agree to the above provisions
It is Duluth Grill family policy that no employee or applicant will be discriminated against because of race, gender, sexual orientation, marital status, color, religion, disability, veteran status or any other characteristic protected by federal, state, or local law. Employment decisions are based on merit, qualifications, and abilities.