Instructions:
· Circle all of the questions on this fictitious application form that could be directly or indirectly related to a prohibited ground of discrimination.
· Come up with alternative ways for those questions you believe directly or indirectly related to a prohibited ground of discrimination.
Employment Application
About Yourself
Preferred Title: ________ First & Last Name: ______________________________________________
Street Address: ____________________City: _______________ Prov: ______ Postal Code: ________
Phone: (___) ____ – _______ Email: _____________________________________________________
Date of Birth: _____ / _____ / _______ Are you a U.S Citizen? Yes [ ] No [ ]
What is your first language? __________________ Can you speak English? Yes [ ] No [ ]
Education and Experience
Secondary School/High School: ___________________________________Graduation Year: ________
Higher Education (circle one; if applicable): College/Trade School/University Program:______________
Name and Address of Most Recent Higher Education Institution: _______________________________
Current/Previous Employer: ______________________ Address: ______________________________
Dates Employed: From ____________ to: ___________ Position Title: __________________________
Position Description: _________________________________________________________________
Please list three references, including names, relationship to you and phone number:
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Desired Job and Availability
[ ] Server
[ ] Kitchen Staff
[ ] Management
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