Employment application

How did you hear about this job opening? What position are you applying for?

Store Associate

Delivery associate

Personal information
First name: Address:
Street City State Zip

Last name:

Phone number: Social security number: Are you at least 16 years of age? Are you at least 18 years of age? Are you legally able to work in the United States? Are you proficient in English? Have you ever been convicted of a crime? Offense: Offense: Offense: Do you have reliable transportation? Do you regularly smoke?

E-mail address: Drivers license number:

Yes Yes Yes Yes Yes Date: Date: Date: Yes Yes

No No No No No

No No

Schedule availability & flexibility

Please list when you are available to work, from a.m. to p.m. If you are completely available on a particular day, leave that box blank. If you are completely unavailable on a particular day, cross that box out.

Monday
to

Tuesday
to

Wednesday
to

Thursday
to

Friday
to

Saturday
to

Sunday to

Please list the shifts you would prefer to work, from a.m. to p.m. If you do not have a preference on a particular day, leave that box blank.

Monday
to

Tuesday
to

Wednesday
to

Thursday
to

Friday
to

Saturday
to

Sunday to

Please list the shifts you would prefer not to work, from a.m. to p.m. If you do not have a preference on a particular day, leave that box blank.

Monday
to

Tuesday
to

Wednesday
to

Thursday
to

Friday
to

Saturday
to

Sunday to

How many weekly hours would you prefer? How many weekly shifts would you prefer? On what date would you be available to start? Are you willing to work weekends? Are you willing to work holidays? Are you willing to work flex shifts?

1-10 1

11-20 3

21-30 4 No No No

31-40

2 Yes Yes Yes

Old Town Pizza Company

Are you willing to work overtime? Are you willing to stay late if needed?

Yes Yes

No No

Employment information
Have you ever applied to our company before? Have you ever worked for our company before? Employer: Supervisor: Co-worker: Address:
Street City State Zip

Yes Yes

No No

If so, when? If so, when?

Please list all work experience, beginning with the most recent.

Phone number: Phone number:

Position: Responsibilities: Reason for leaving:

Salary:

Start date:

End date:

Please circle how this employer would rate you on the following characteristics.

1
[Poor]

2
[Below average]

3
[Average]

4
[Above average]

5
[Excellent]

Dependability Initiative Flexibility

`

1 1 1 1 1

2 2 2 2 2 Yes

3 3 3 3 3 No

4 4 4 4 4

5 5 5 5 5 Yes

Coachability Urgency

Are you eligible for rehire? Employer: Supervisor: Co-worker: Address:

May we contact this employer?

No

Phone number: Phone number:

Street City State Zip

Position: Responsibilities: Reason for leaving:

Salary:

Start date:

End date:

Please circle how this employer would rate you on the following characteristics.

1
[Poor]

2
[Below average]

3
[Average]

4
[Above average]

5
[Excellent]

Dependability Initiative Flexibility Coachability Urgency

1 1 1 1 1

2 2 2 2 2 Yes

3 3 3 3 3 No

4 4 4 4 4

5 5 5 5 5 Yes

Are you eligible for rehire? Employer:

May we contact this employer?

No

Old Town Pizza Company

Supervisor: Co-worker: Address:

Street

Phone number: Phone number:

City State Zip

Position: Responsibilities: Reason for leaving:

Salary:

Start date:

End date:

Please circle how this employer would rate you on the following characteristics.

1
[Poor]

2
[Below average]

3
[Average]

4
[Above average]

5
[Excellent]

Dependability Initiative Flexibility Coachability Urgency

1 1 1 1 1

2 2 2 2 2 Yes

3 3 3 3 3 No

4 4 4 4 4

5 5 5 5 5 Yes

Are you eligible for rehire?

May we contact this employer?

No

Education
Please circle the highest year of schooling youve completed in each category.

Elementary: Name: Location:

1 2 3 4 5 6 7 8

Secondary: Name: Location:

9 10 11 12 GED

College: Name: Location: Major:

1 2 3 4 5 6 7 8

References
Please list your professional references. Do not include personal friends or family members.

Name: Name: Name:

Phone number: Phone number: Phone number:

Relationship: Relationship: Relationship:

Pre-interview questions
Why do you want to work here?

Why should we hire you?

I have personally completed this application. I affirm that all information in this application is true and complete. I understand that any misrepresentations, false statements, or omission of facts shall be grounds for refusal of employment, or if hired, termination. I understand that an incomplete application will make me ineligible for employment. I authorize this company to make an investigation of all information contained in this application, and I release my current and former employers and co-workers from liability for providing, verifying, and elaborating on said information to this company. I understand that this application is valid and active for only thirty (30) days, after which it expires.

Signature:

Date:

Old Town Pizza Company