Name

Address

City                             State               Zip
   

Phone Number

Date of Birth

Pay requirements, Server Minimum Plus Gratuities,
Minimum Wage plus Gratuities, Other

Type of Work Interested In
Banquets Restaurants Private Parties
Special Events Other

Days Available
Monday Tuesday Wednesday Thursday
Friday Saturday Sunday

Hours Available
Days Nights Third Shift Any

Noticed Required (Pick One)
None 1 Day 2 Days More

Type of Service
1-2 Star 3-4 Star 5 Star All Not Sure

Do you have any Tattoos or Piercings that would be visible When Serving?
If Yes Explain.

Is it OK for a establishment to contact you directly?

Do you have any limitations? If yes Explain.

Describe in Detail anything that may assist us in placing you with
a great place to work.

I have read the disclaimer and by digitally signing I Agree
(Initials)

Disclaimer

We offer no guarantee of work, work environment, pay, dependability, availability, reliability or any other guarantee. We only offer you the connection of server and establishment. You agree that you will be not except a full time/permanentemployment with any establishment contracted through NYSSRP without first getting authorization from NYSSRP. There is a permanent placement fee that must be paid prior to hiring a server permanently. This fee is to be paid by the hiring establishment.  Failure to follow our guidelines will result in immediate and permanent removal from out referral base.