Hiroshi Teriyaki Grill
6628 W 10th St #103, Greeley, CO 80634 | West Greeley
808 23rd St, Greeley, CO 80631 | East Greeley
4904 Larimer Pkwy, Johnstown, CO 80534 | Johnstown Plaza
Coming Soon | Evans, CO

Application For Employment

Which location(s) are you interested in applying to?

West Greeley Johnstown Plaza East Greeley Any/All Locations

Applicant Information

Last Name

First Name

M.I.

Street Address

Unit #

City

State

Zip

Phone

Date Availible

Desired Pay Rate

Are you a U.S. citizen? Yes No

Have you ever been convicted of a felony? (Don't include minor traffic violations)
Yes No

Education

High School

Name of School

City & State

Attended From To

Did you Graduate? Yes No

College

Did you attend College? Yes No

Additional Schooling

Would you like to include additional schooling?
Yes No

References

First Reference

Full Name

Relationship

Phone Number

Company

Address

Second Reference

Would you like to include a second reference?
Yes No

Third Reference

Would you like to include a third reference?
Yes No

Employment History

Employer 1

Would you like to include a previous/current employer?
Yes No

Employer 2

Would you like to include a second previous/current employer?
Yes No

Employer 3

Would you like to include a third previous/current employer?
Yes No

Why do you want to work for us?

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

SIGNATURE
(Please Type Your FULL Name)

Date

Please Verify You Are Human :-)