Pudgie's Pizza Employment

Name

Telephone

E-Mail Address

Address

Street Address

City

State

Zip Code

Referred By

Emergency Contact

Name

Phone Number

Are you presently employed?

Yes

No

May we inquire your present employer?

Yes

No

Have you applied with us before?

Yes

No

If yes, when and where?

Position applying for

Would you be interested in Delivery?

Yes

No

When can you start?

Desired hourly rate?

Are you 18 years of age or older?

Yes

No

Do you have a valid NYS drivers license?

Yes

No

Are you willing/able to travel for training?

Yes

No

High School Name and Address

Years Attended

College Name and Address

Years Attended

Trade School Name and Address

Years Attended

Previous Employer #1(Most Recent)

Previous employer #1

Previous employer #1 address

Previous employer #1 hourly rate

Previous employer #1 reason for leaving

Previous Employer #2

Previous employer #2

Previous employer #2 address

Previous employer #2 hourly rate

Previous employer #2 reason for leaving

Previous Employer #3

Previous employer #3

Previous employer #3 address

Previous employer #3 hourly rate

Previous employer #3 reason for leaving

Reference #1

Reference #1 name and association

Reference #1 phone number

Reference #2

Reference #2 name and association

Reference #2 phone number

Reference #3

Reference #3 name and association

Reference #3 phone number

Have you been vaccinated from Covid-19?

Yes

No

If so, when was your last dose?

Authorization - "I here by certify that all the facts in this application are true and factual to the best of my knowledge, and if employed any falsified statement may be grounds for dismissal"

I agree

Employment application

Previous Employer #1(Most Recent)

Previous Employer #2

Previous Employer #3

Reference #1

Reference #2

Reference #3

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