· 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 [ ]

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