Donelly's Pizza Employment Application

Equal Opportunity Employer It is our policy to abide by all Federal and State laws prohibiting employment discrimination solely on the basis of a person's race, color, creed, national origin, religion, age (over 40), sex, marital status, or physical or mental disability, except where reasonable, bona fide occupational qualification exists. 

Name S.S. #
Address How Long?
City State / Zip
Phone D.O.B.
Position for which you are applying?
Availability
If Part Time, Specify Hours or Days
Date Available for Work
Minimum Salary Requirements
Do you have any commitments to another employer that might affect your employment with us?   

Education and Training

School Name City / State Degree / Major Degree Received
High School
College
Grad. School
Trade School

Employment History (List most recent employment first)

1.

Employer Type of Business
Address City / Business
Dates Employed Position
Supervisor's Name Phone Number
May we contact? Reason for leaving?

2.

Employer Type of Business
Address City / Business
Dates Employed Position
Supervisor's Name Phone Number
May we contact? Reason for leaving?

3.

Employer Type of Business
Address City / Business
Dates Employed Position
Supervisor's Name Phone Number
May we contact? Reason for leaving?
List any other education, training, special skills or certificates / licenses that you possess related to the job. 
Do you have a valid Driver's License in this state?
If you are applying for a driving position, do you have valid and up-to-date insurance on the vehicle you will be delivering in?     
Can you, after employment, submit verification of your legal right to work permanently
in the U.S.?    
List any friends or relatives who currently or have worked for Donelly's Pizza. 
During the last ten years, have you ever been convicted of, plead guilty to, or received probation, deferred adjunction, or any other type of alternative method of supervision or correction for a felony or misdemeanor?     If yes, explain. 
Can you perform the essential functions of the job? 
Do you require any accommodation to perform the essential functions of the job?  
If yes, explain. 

Business References (List three individuals, in addition to listed employment references, known to you for at least three years.)

Name Occupation / Association Phone Number
1
2
3

Person to be notified in case of emergency:

Name Phone
Address City / State / Zip

Please include any other information you think would be helpful to us in considering you for employment, such as additional work experience; articles/books published, activities, honors received, etc.  (You may omit all information that would indicate age, sex, sexual orientation, race, religion, color, national origin, or disability. 

Agreement (Please read the following statement carefully)

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to be the best of my knowledge.  I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I authorize all persons listed above (and on the accompanying resume, if any) to give Donelly's Pizza any and all information concerning my previous employment and education and any pertinent information they may have, personal or furnishing same to Donelly's Pizza.

If employed by Donelly's Pizza, I agree to abide by all policies and procedures of Donelly's Pizza.  I further understand that my employment can be terminated, with or without cause or notice, at any time, at the discretion of Donelly's Pizza.

   

If this application is accepted by Donelly's Pizza, we will call you in for an interview.