Cheezy’s Pizza & Subs Employment Application

We are an Equal Opportunity Employer. All applicants are considered without regard to race, color, religion, disability, sex, national origin, age, or any other basis protected by federal, state, or local law. This employment application is only active for 30 days. After this time period a separate employment application must be submitted in order to be considered for employment.

PERSONAL
First name:		Middle name:		Last name:
Street address:		City/State/Zip:
Social Security No.:		Phone:
How did you find out about this job? Newspaper Referral Other
If hired, do you have a reliable means of transportation to get to work? Yes No What is it?
Minimum salary expected:
Are you at least 18 years old?	Yes No
If the job you are applying for requires driving:
Driver’s License No.:
State Issued:
Expiration Date:
Are you legally eligible for employment in the U.S.?			Yes No
(Proof of U.S. citizenship or immigration status will be required if hired.)

Have you been convicted of a crime, other than a minor traffic violation, in the last ten years?			Yes No
If yes, state the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.)

EDUCATIONAL (Click highest level attained.)
Elementary: 1 2 3 4 5 6 7 8		Secondary: 1 2 3 4 5 6 7 8
College: 1 2 3 4 5 6 7 8
Name of School		Location of School
Name of School		Location of School
Name of School		Location of School
If currently in high school, are you enrolled in a recognized co-op program? Yes No
Degree & Major

If yes, identify program and school:		Minor:

Name	Title	Company	Phone	Professional Relationship
PERSONAL REFERENCES

EMPLOYMENT DATA

Are you seeking:
Temporary Full-time Part-time

What position(s) are you applying for? Please indicate any shift(s) you would not be available to work.

Are you willing to work overtime? Yes No
Weekends? Yes No
Holidays? Yes No

Are you currently employed? Yes No
If hired, when would you be able to start?

Have you ever worked for this organization before? Yes No
If yes, name used:

List any friends or relatives employed by this company:

Are you on layoff and subject to recall? Yes No

Have you ever been discharged or asked to resign from any position? Yes No
If yes, please describe:

How many days have you missed from school or work within the last year other than approved vacation, sick, or disability leave?

How many days have you been late to school or work within the last year other than approved vacation, sick, or disability leave? Please describe:

Are you able to perform the tasks required for the job you are applying for with or without reasonable accommodation?
Yes No

Please describe which tasks, if any, you will need and accommodation to perform, and explain what type of accommodation you will need:

WORK HISTORY (Please list your last Three employers. Begin with the most recent.)

Company:		Phone No.:
Address:		City/State/Zip:
Dates of Employment:	-	Salary:	-
Job Title:		Supervisor’s Name & Title:
Describe duties briefly:
Specific reason for leaving:

Company:		Phone No.:
Address:		City/State/Zip:
Dates of Employment:	-	Salary:	-
Job Title:		Supervisor’s Name & Title:
Describe duties briefly:
Specific reason for leaving:

Company:		Phone No.:
Address:		City/State/Zip:
Dates of Employment:	-	Salary:	-
Job Title:		Supervisor’s Name & Title:
Describe duties briefly:
Specific reason for leaving:

May we contact all of the employers listed above? Yes No
If not, tell us which one(s) you do not wish us to contact and why.

How many jobs have you had in the last five years not listed above?

Why are you seeking a new position at this time?

List any business-related outside interests and organizations you’re active in:

Please select an "Yes" or "No" for the shifts you can work
	Mon	Tue	Wed	Thur	Fri	Sat	Sun
AM	Yes No	Yes No	Yes No	Yes No	Yes No	Yes No	Yes No
PM	Yes No	Yes No	Yes No	Yes No	Yes No	Yes No	Yes No

Please read the following carefully, then sign and date the application.

I authorize Cheezy’s Pizza & Subs to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge. Upon termination of my employment for whatever reason, I release Cheezy’s Pizza & Subs from all liability for supplying any information concerning my employment to any potential employer. I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations. I hereby agree to submit to any drug/alcohol test required of me, whether prior to my employment or if employed by Cheezy’s Pizza & Subs at any time thereafter. I understand and expressly agree that if employed by the company, storage areas provided for me (locker, desk, etc.) are open to investigation or search by the company without prior notice to me. I further understand this is an application for employment and that no employment contract is being offered. I understand that if I am employed, such employment is for an indefinite period of time and the company may change wages, benefits, and conditions at any time. My employment is at will. No individual with the company is authorized to change the employment-at-will status except an officer of the company, who may do so only in writing. I have read and understand the above.