111 South Main St.,
Trucksville, PA 18708
570-696-3580

Reserve Now
Hours of Operations
Lunch: Monday-Saturday:
11:30am - 4:30pm

Dinner: Monday 4:30pm - 8:00pm

Tuesday-Thursday:
4:30pm - 9:00pm

Friday & Saturday:
4:30pm - 9:30pm

Sunday Dinner:
4:00pm - 8:00pm

Half Price Happy Hour: Mon-Sat
5:00pm - 6:00pm



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PERSONAL INFORMATION



First, M.I., Last Name:

Address:
City, State, Zip:
Phone Number:
Social Security Number:

I am 18 or over: yes no
Are you prevented from lawfully becoming employed in this country 
because of Visa or immigrant status?
yes no



EMPLOYMENT DESIRED






Position:
Date you can Start:
Salary Desired:
Are you employed Now?
If yes, can we inquire of your present employer?
Have you ever applied to this company before?
If yes, where? when?
Referred by:

EDUCATION
Grammar







School Name:
Address:

City, State, Zip:
Number of years attended:
Did you graduate?
Subjects Studied:

High School




School Name:

Address:
City, State, Zip:
Number of years attended:

Did you graduate?
Subjects Studied:

College/University




School Name:

Address:
City, State, Zip:
Number of years attended:

Did you graduate?
Subjects Studied:

Trade/Business or Correspondence






School Name:
Address:
City, State, Zip:
Number of years attended:

Did you graduate?
Subjects Studied:
GENERAL

Subjects of special study or research work:
Special Skills:
Activities: (Civic, Athletic, etc.) *exclude organizations, the name of which indicates the race, creed, sex,
age, marital status, color or nation of origin of its members






U.S. Military or Naval Service:
Rank:
Present membership in:  
National Guard or Reserves:
FORMER EMPLOYERS
List below last three employers, starting with the most recent one first.
Employer 1








Employer Name:
Address:
City, State, Zip:

Date Started:
Date Resigned:
Salary:

Position:
Reason for Leaving:

Employer 2








Employer Name:
Address:
City, State, Zip:

Date Started:
Date Resigned:
Salary:
Position:
Reason for Leaving:


Employer 3








Employer Name:
Address:
City, State, Zip:
Date Started:
Date Resigned:
Salary:
Position:

Reason for Leaving:





Which of these jobs did you like best?
What did you like most about this job?
REFERENCES
Give the names of three persons not related to you, whom you have known for at 
least one year.
Reference 1






Name:
Address:
City, State, Zip:

Business:
Years Aquainted:

Reference 2








Name:
Address:
City, State, Zip:
Business:
Years Aquainted:

Reference 3


Name:

Address:
City, State, Zip:
Business:

Years Aquainted: