MR. ROGERS NEIGHBORHOOD DINER

Join the neighborhood.

Employment application

Apply to Mr. Rogers Neighborhood Diner.

Complete the form, then choose “Email application” to open your email app. Review the completed application and press Send there to email mrrogersneighborhooddiner@gmail.com. You can also save or print a copy to bring to 1304 Highway 13 North, Columbia, MS 39429.

Fields marked * are required. Please do not include your Social Security number, banking information, or identification documents. Your answers are not saved when you leave or refresh this page.

1. Contact information

Full name Phone number Email addressCity and state Best way to reach you

2. Position and availability

Position of interest *Other position (if applicable)Employment preference *Available start date Desired hourly pay (optional)Restaurant experience, skills, or certifications (if any)

Enter the times you can work each day, or write “unavailable.”

MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Anything else we should know about your availability?

3. Work history

No previous work experience? That’s okay—leave this section blank.

Previous job 1 (optional)

EmployerJob titleStart monthEnd month (leave blank if current)Duties and experienceReason for leavingMay we contact this employer?

Previous job 2 (optional)

EmployerJob titleStart monthEnd month (leave blank if current)Duties and experienceReason for leavingMay we contact this employer?

4. Reference (optional)

Someone familiar with your work, school, or volunteer experience. Ask their permission before sharing their contact information.

Reference nameRelationshipPhone or email

5. Review and signI confirm that the information I provided is accurate to the best of my knowledge. *

Typed name Date

Questions? Call 601-441-8515.

Mr. Rogers Neighborhood Diner · 1304 Highway 13 North · Columbia, MS 39429 · 601-441-8515