Careers – Bottoms Up Pizza

First Name

Middle Name

Last Name

Birth Date

Phone Number

E-mail Address

Street Address

Street Address Line 2

City

State

Postal / Zip Code

Position youare applying for

Server

Host / Hostess

Busser

Dishwasher

Bartender

Runner

Line Cook

Cashier

Driver

Hourly Wage Desired

Date You Can Start

WIlling to Relocate?

Yes No N/A

Work History

Please list your three (3) most recent jobs.

Company Name 1

Title

Length of Employment

Address

Address Line 2

City

State

Postal / Zip Code

Last Hourly Rate of Pay

Reason for Leaving

Personal Reason

Medical Benefits

Quality of Supervision

Work Environment

Other

Company Name 2

Title

Length of Employment

Address

Address Line 2

City

State

Postal / Zip Code

Last Hourly Rate of Pay

Reason for Leaving

Personal Reason

Medical Benefits

Quality of Supervision

Work Environment

Other

Company Name 3

Title

Length of Employment

Address

Address Line 2

City

State

Postal / Zip Code

Last Hourly Rate of Pay

Reason for Leaving

Personal Reason

Medical Benefits

Quality of Supervision

Work Environment

Other

EMPLOYMENT APPLICATION STATEMENT

By submitting this form I hereby represent that each answer is truthful and constitutes a full and complete disclosure of my knowledge with respect to the questions and I understand that any misrepresentation of facts shall constitute cause for dismissal regardless of when discovered. In the event that I become an employee, I agree to comply with all rules and regulations.

REFERENCE RELEASE

By submitting this form I hereby authorize any idividual, employer, or law enforcement agency to furnish any information concerning my employability, my previous work and/or academic record, whether same is of record or not, and do hereby release the individual, employer, or law enforcement agency and all the individuals connected therewithin from all liability for any damage incurred in furnishing this information.

I accept

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The filing of an application does not imply that the applicant will eventually be employed but that the application will be considered, when a vacancy occurs, in competition with other applicants. All applicants will be given equal opportunity regardless of race, color, religion, national origin, ancestry, sex, age, disability, height, weight, marital status or veteran status. It is our policy that no person shall be discriminated against, excluded from participation in, denied the benefits of, or otherwise be subjected to discrimination in employment on the basis of race, color, national origin or ancestry, sex, age, disability, religion, height, weight, marital status or veteran status.