Please complete the following Employment Application.

Personal Information

First Name: Last Name:
City: State: Zip :
Home Phone:
Mobile Phone:
email address:
If you are under the age of 18, can you provide a work permit? Yes    No

Position Seeking

Postion Applying for:
Type of employment:
Desired Location:
Bartlett     Kirby Gate     Raleigh     Whitehaven     Wolf River
Date Available to Start:
Salary Requirements:
    Monday     Tuesday     Wednesday     Thursday     Friday     Saturday     Sunday
Are you legally allowed to work in the United States?: Yes    No
Are you currently employed? : Yes    No
If Yes, may we contact your current employer: Yes    No
Have you ever applied at Exlines’ before? : Yes    No
Have you ever employed at Exlines’ before? : Yes    No

Those applying for management, cashier or serverpositions must have a beer I.D. card when they are hired.
All expenses are the applicant’s responsibility.

The criminal background check can be done online at a cost of $29.00.
A copy must be presented tothe alcohol commission to get the beer I.D. card which is $21.00.

Do you currently have a Beer I.D. card?: Yes    No       If Yes, when does it expire?:
Have you ever taken a Serve Safe class?: Yes    No
If Yes, did you get certified?: Yes    No       If Yes, year of certification?:


Years Attended: Did you graduate? Subjects Studied
High School Yes    No
Trade, Business or
Correspondence School
Yes    No
College Yes    No

Former Employers

Employer Name 1:
Start Date: End Date:
Salary: Position:
Reason for Leaving:

Employer Name 2:
Start Date: End Date:
Salary: Position:
Reason for Leaving:

Employer Name 3:
Start Date: End Date:
Salary: Position:
Reason for Leaving:


Name Address Phone Number Relationship Years Known

Have you ever plead guilty, no contest or been convicted of a crime? Yes    No
If Yes, please provide dates and details:
Answering yes to these questions does not constitute an automatic rejection for employment.
Date of offence, seriousness and nature of the violation, rehabilitation and position applied for
will be considered.


I certify that the facts contained in this application are true and complete to the best of my knowledge
and understand the, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers lists above
to give you and all information concerning my previous employment and any pertinent information they
may have, personal or otherwise, and release the company from all liability for any damage that may
result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any
agreement for employment for any specified period of time, or to make any agreement contrary to the
foregoing, unless it is in writing and signed by an authorized company representative.

Exlines' is an Equal Opportunity Employer

By clicking this checkbox and clicking Submit you agree to the above terms.