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Employment Application

Your Name

Last Name: First Name: Middle Name:

Telephone: SSN #:

Present Address

Street: City: State: Zip:

Permanent Address

Street: City: State: Zip:

In Case Of Emergency Notify:

Name: Relation: Phone:

Street: City: State: Zip:

Position desired: Date Available: Are you currently employed? Yes

What hours can you work?

Number of hours you wish to work

Days you wish to work: Mon Tue Wed Thu Fri Sat Sun

Do you have any previous pizza or restaurant experience? Yes

Where?

When?

Have you ever applied to or worked for Round Table Pizza? Yes

Where?

When?

Name of last supervisor at Round Table Pizza?

Reason for leaving

Do you have any friends or relatives working for Round Table Pizza? Yes

If yes, state name(s) and relationship:

Why are you applying for work at Round Table Pizza?

If hired, would you have a reliable means of transportation to/from work? Yes

Are you at least 18 years old? Yes

(if under 18, hire is subject to verification that you are of minimum legal age.)

If hired, can you present the essential functions and all other duties of the job for which you are applying? Yes

If no, describe the duties and functions that you cannot perform:

Have you ever been convicted of a felony? Yes

If yes, state nature of the crime(s), when and where convicted, and disposition of the case:

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offence to the position(s) applied for may, however, be considered.)

Education, Training & Experience

School	Name & Address	No. Of Years Completed	Did You Graduate?	Degree Or Diploma
High School			Yes No
College/University			Yes No
Vocational/Business			Yes No
Other			Yes No

Many of our customers do not speak English. Do you speak, write or understand any foreign languages?

Do you have any other experience, training, qualifications or skills which you feel make you especially suited for work at Round Table Pizza?

Employment History

List below all present and past employment starting with your most recent employer:

Date of Employ.		Name/Location	Position/Duties	Salary	Reason For Leaving
From: To:
		May we contact? Yes
From: To:
		May we contact? Yes
From: To:
		May we contact? Yes
From: To:
		May we contact? Yes

References

List below three persons, who are not relatives, whom you have known for at least one year:

Name & Address	Telephone	Relationship	Years Known

Please Read (application certification, authorizations and understandings):

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I agree that if I am made an offer of employment with Round Table Pizza, my employment can be terminated "at-will" by me or the company for any reason or no reason. Any agreement that alters the at-will employment relationship must be in writing and signed by both me and the company president. This is a integrated agreement regarding the at-will nature of my employment.

I hereby authorize Round Table Pizza to thoroughly investigate my referenceus, work record, education and other matters related to my suitability for employment and further, authorize my former employers to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Round Table Pizza, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

Please type your full name in the box below. By submitting this application online, your computer's IP address will be recorded as part of your "electronic signature".

Full Name: