Brown Dog Pizza Employment Application

PERSONAL INFORMATION

Date: Feb-23-2012

Position(s) Applied For:

Last Name:

First Name:

Address:
City:
State:   Zip:

Phone: () -

Social Security Number: --

Date available to work: / / (format: MM / DD / YYYY)

Email Address:

Are you available to work: Select Full Time Part Time Temporary

Shifts available: Select Mornings Afternoon Evenings

Days of the week available: Sun Mon Tue Wed Thu Fri Sat

What is your desired salary range:

Are you currently employed: Select Yes No

May we contact your current/past employer: Select Yes No

Are you prevented from lawful employment in this country because of Visa or Immigration Status?

Have you ever been convicted of a felony: Select Yes No

EDUCATION

High School:

College:

Other:

Course of Study:

Did you graduate: High School Select Yes No College Select Yes No

WORK EXPERIENCE

Employer:

Address:

Phone: ( ) -

Supervisor:

Starting/Present Job Title:

Dates Employed: From / / To / /

Hourly rate/Salary: Start Final

Duties:

Reason for leaving:

---

Employer:

Address:

Phone: ( ) -

Supervisor:

Starting/Present Job Title:

Dates Employed: From / / To / /

Hourly rate/Salary: Start Final

Duties:

Reason for leaving:

---

Employer:

Address:

Phone: ( ) -

Supervisor:

Starting/Present Job Title:

Dates Employed: From / / To / /

Hourly rate/Salary: Start Final

Duties:

Reason for leaving:

Comments: (include explanation of any gaps in employment)

List any specialized training, skills, professional, trade, business or civic activities:

Extra-Curricular Activities:

Specialized Skills: Typewriter Word Excel Powerpoint Word Processing Shorthand Access Quickbooks

Any additional programs:

PERSONAL / PROFESSIONAL REFERENCES

Name:

Phone:( ) -

Occupation:

---

Name:

Phone:( ) -

Occupation:

---

Name:

Phone:( ) -

Occupation:

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Name:

Phone:( ) -

Occupation:

NOTE; This section must be filled out in its entirety before submitting resume.

APPLICANT'S SIGNATURE

By checking this box, I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment is considered active for a period not to exceed 45 days. Any applicant wishing consideration for employment beyond this time should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the employee may resign at any time and the employer may discharge at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless an authorized executive of this company specifically acknowledges such change in writing.

In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

 

SECURITY

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