Lake Park Bistro

Red fields are required.

Applying For

Have you ever been convicted of a crime?


Are you a War Veteran?


Employment History

List your employers starting with the current or most recent first.

Employer 1

Contact as Reference?

Employer 2

Contact as Reference?

Employer 3

Contact as Reference?

1. I do hereby authorize the investigation of all statements contained in this application for employment.

2. I understand that misrepresentation or omission of facts called for is cause for dismissal and that my employment is substantially dependent on the truthful answers to the foregoing inquiries.

3. I authorize any former employer, person, firm, corporation, school, or government agency to release any and all information concerning my former employment to this prospective employer. I understand that the information may include, but not limited to, performance evaluations and reports, job descriptions, disciplinary reports, letters of reprimand, opinions, and public record information regarding my suitability for employment. I recognize that a copy of the authorization and release is as valid as the original and should be considered as such.



NOTICE: Applicant should read the following information carefully before filling out any of the questions in this form. Title VII of the Civil Rights Act of 1964, as amended, prohibits discrimination in employment because of race, color, sex, religion, or national origin. It is also illegal to discriminate in employment of persons because of their age if over 40 but less than 70 years of age, or because of a handicap

We invite all applicants, who believe themselves covered by the Rehabilitation Act of 1973 and the Vietnam Era Veteran’s Readjustment Assistance Act of 1974 and who wish to benefit under this Affirmative Action Plan, to voluntarily and confidentially, identify yourself to the EEO Coordinator by calling 414-258-7885 ext. 208. Refusal to provide it will not subject you to any adverse treatment and that it will be used only in accordance with the above Acts.