Papa Leo's Employment Application

Position Applying For:

Last Name:

First Name:

Middle Name:

Social Security #

Street Address:

Apt. #

City:

State:

ZIP:

Home Telephone Number:

Work or cell Telephone Number:

May we contact you at work? Yes No

If you are a finalist for this position, may we contact your current employer for a reference? Yes No

Are you legally eligible for employment in the United States? Yes No

YOUR AGE:
(certain equipment cannot be operated by people under 18)

Are you aware of any reason you cannot perform the essential functions of this job with or without reasonable accommodation? Yes No

Do you have relatives or friends working for Papa Leo’s? Yes No

Dept.:

Name:

Relationship:

Veterans' Preference Points

Dates of Service

Driver’s License
Number State

Which of the following do you have? High School Diploma GED

PLEASE LIST BELOW ALL EDUCATION BEYOND HIGH SCHOOL

List any special training, workshops, seminars, etc. in which you have participated which relate to or are required for this position(s), certification(s), or other miscellaneous qualifications.

Do you own an automobile that can be used by you to deliver Pizza to customers?
Yes No

Is it insured by you?:
Yes No

Employment History

Beginning with your most recent job, list all employment for the last 3 Positions.

Reason for Leaving

Description of Duties:

Reason for Leaving

Description of Duties:

Reason for Leaving

Description of Duties:

Have you ever been convicted of a felony?
Yes No

Have you been convicted of a misdemeanor during the last five years?
Yes No

If you answered yes to either question, please explain: