Pizza Shuttle

Last Name: *

First Name: *

Middle Initial: *

Telephone Number: *

Address-Street: *

City/State/Zip: *

SSN #: *

Under 18?: *

For what position are you applying?: *

What date can you start?: *

Full or Part Time?: *

Availability for Sunday (AM-PM): *

Please list the available hours you can work.

Availability for Monday (AM-PM): *

Availability for Tuesday (AM-PM): *

Availability for Wednesday (AM-PM): *

Availability for Thursday (AM-PM): *

Availability for Friday (AM-PM): *

Availability for Saturday (AM-PM): *

Minimum hours you would like to work each week?: *

Maximum hours you would like to work each week?: *

How many years completed in high school?: *

GPA?: *

Name of High School?: *

City/State of HS: *

Name of Undergraduate School?: *

City/State of College: *

Did you graduate?: *

No. of credits?: *

Major?: *

Minor?: *

Type of Degree?: *

Cumulative GPA?: *

SPECIAL COURSES(Graduate, Business, Correspondence, Trade Schools?) Yes/no?: *

Name of School: *

City/State of School: *

Course taken/When completed: *

Name of School: *

City/State of School: *

Course taken/When Completed: *

Please list skills (List all skills you feel may be helpful): *

Have you ever performed any of the following:: *

Delivery, Dish/Cleaning, Cook, Pizza Making, Phone Experience, Prep Cook, Register. List all that apply.

Are you an United States Citizen? If not please explain.: *

Driver or Chauffeur's License Number:

Answer only if you are seeking Driver's Position?

Has your license been revoked or suspended? Yes/No?:

Accidents::

Have you had an accident resulting in serious injury to others and/or property damage? Yes/No?

If yes, please explain.:

Drivers License Number:

Do you have a car? YEAR & MAKE:

Auto Insurance Company & Policy #:

Do you have any MOVING traffic violations? :

Please list them by last date first. (DATE VIOLATION PENALTY)

Previous Employment: Company Name: *

Most Recent Employer

Street/City: *

Telephone Number: *

Type of work done:: *

Whom may we contact? (Name/Title): *

Reason for Leaving?: *

Date Started: *

MO/DAY/YEAR

Date Left: *

MO/DAY/YEAR

Beginning Rate of Pay ($ per hour): *

Final Pay ($ per hour): *

Company Name: *

Street/City: *

Telephone Number: *

Type of work done:: *

Whom may we contact? (Name/Title): *

Reason for Leaving?: *

Date Started: *

MO/DAY/YEAR

Date Left: *

MO/DAY/YEAR

Beginning Rate of Pay ($ per hour): *

Final Pay ($ per hour): *

Signature: *

APPLICANT PLEASE READ BEFORE SIGNING:

I certify that the information I have given on this application is true and complete. I understand that any false or misleading information given, or the omission of any pertinent information including that given at the time of a pre-employment drug test and/or post-offer physical exam, may result in my discharge, at any time, if I am hired. I hereby waive and release to the Company any privilege which I may now have with respect to medical information disclosed by examination, by investigation of, or communication to physicians employed by the Company.

I hereby authorize the Company to investigate my record with my former employers, personal references and creditors and to obtain a consumer report as defined under Section 603(d) of the Fair Credit Reporting Act; also I release the Company and all informants form all liability whatsoever resulting from such an investigation. I understand that I may request information as to the purpose of the consumer report and if employment i denied on the basis of information obtained in the credit report, the name and address of the consumer reporting agency. I waive any rights I may have to receive written notice from any former employer listed on this application regarding the release to the Company of any information concerning any disciplinary action taken against me, by said former employer.

IF HIRED, I AGREE TO ABIDE BY THE POLICIES AND EXPECTATIONS OF THE COMPANY. I ALSO UNDERSTAND THAT ALL EMPLOYEES ARE FREE TO LEAVE THE COMPANY'S EMPLOYMENT AT ANYTIME FOR ANY REASON AND THAT MY EMPLOYMENT MAY BE TERMINATED BY THE COMPANY AT ANYTIME, WITH OR WITHOUT CAUSE. NOTHING WITHIN ANY COMPANY POLICY, PROCEDURE OR PROGRAM IS INTENDED OR SHALL BE CONSTRUED AS AN IMPLIED OR EXPRESS CONTRACT OF EMPLOYMENT. IT IS EXPRESSLY UNDERSTOOD THAT NO PERSON WITH THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY VERBAL CONTRACT OF EMPLOYMENT OR PROMISE OF CONTINUED EMPLOYMENT ON BEHALF OF THE COMPANY. ONLY A WRITTEN EMPLOYMENT AGREEMENT AUTHORIZED BY THE BOARD OF DIRECTORS AND SIGNED BY THE CHAIRMAN OF THE BOARD AND/OR PRESIDENT OF THE COMPANY SHALL BE BINDING UPON THE COMPANY.

In the event the Company advances me money or the other items of value, or I otherwise become indebted financially to the Company, I agree to repay the Company and also that any wages due me upon termination may be offset by payroll deduction against any such monies due to the Company.

PLEASE ENTER YOUR NAME

Date of Signature: *