Application for Employment

Applicant Information
Full Name:Date:
Last / M.I. / Firstmm/dd/yyyy
 
Address:  Street:Apt/unit#
City:State:Zipcode:
Phone:(with area code)E-mail:
Date Available:Desired Salary:

 

Position Applied for:
(to select multiple items hold down the CTRL key while selecting)

 

To help protect your privacy we do not collect Social Security Numbers over the net. If hired that information will be requested at that time.

 

Are you a citizen of the United States?If no are you authorized to work in United States?
YesNoYesNo

 

Have you ever been convicted of a driving violation?If so when?
YesNo

 

Have you ever been convicted of a felony?If yes explain.
YesNo
(If you are offered employment, you will be required by Federal law to furnish documents showing you are either a citizen or an authorized alien. Individuals who do not furnish these documents cannot work for the company.)

Education
High School:Address:
From:To:
Did you graduate?Degree?
YesNo

 

College:Address:
From:To:
Did you graduate?Degree?
YesNo

 

Other:Address:
From:To:
Did you graduate?Degree?
YesNo

Availability
 SundayMondayTuesdayWednesdayThursdayFridaySaturday
Lunch (Open - 3pm)YesNoYesNoYesNo YesNoYesNoYesNo YesNo
Dinner (4:30 - Close) YesNoYesNoYesNo YesNoYesNoYesNo YesNo
Please specify other hours you can work in the box below
If hired do you have a reliable means of transportation to get to work?Are you under 21 years old?
YesNoYesNo
Describe: If yes list Date of birth: 
                                      mm/dd/yyyy

 

Are you at least 18 years old?If under 18 can you furnish a work permit?
YesNoYesNo

 

If the job you are applying for requires driving please furnish:
Drivers License Number: State:   Expiration Date: 

Previous Employment

 

company:Phone:
Address:Supervisor:
Job Title:
Starting Salary:Ending Salary
Please list your job responsibilities in the box to the right:
Start Date:End Date:
Reason for leaving:
May we contact your supervisor? YesNo

 

company:Phone:
Address:Supervisor:
Job Title:
Starting Salary:Ending Salary
Please list your job responsibilities in the box to the right:
Start Date:End Date:
Reason for leaving:
May we contact your supervisor? YesNo

 

company:Phone:
Address:Supervisor:
Job Title:
Starting Salary:Ending Salary
Please list your job responsibilities in the box to the right:
Start Date:End Date:
Reason for leaving:
May we contact your supervisor? YesNo

 

Military Service

 

Branch:
From:To:
Rank at discharge:Type of discharge:
If other than honorable explain:

 

Please give a brief description of what you may be able to bring to Dom DiCarlo's to help the team:

 

Disclaimer and Signature

 

I accept:

Thank you for your interest in working at Dom DiCarlo's
If considered for employment we will contact you
for an interview or further follow-up