Employment Application

Todays Date: 1/21/2015

First Name:

Email Address: addiek4@gmail.com

Addison

Middle Initial

Last Name:

Street Address: 333 E. Lovett

City:

Name

State:

No Home Phone
of

City:
Name

Apartment Number:

Charlotte

Phone Number:

high

school

MI

Zip Code:

attended:

to

contact

as

reference:

48813

1-517-281-4198

Charlotte
State:

teacher/counselor

Name of college attended:

N/A

Cell Phone Number:

Charlotte
of

Kimmer

Public
MI

Mrs.

High

School

Zip Code:

Crossman

or

Mrs.

48813

Wellfare

Department:

N/A

City:

State:

Zip Code:

What position are you applying for? Pizza maker

What type of position are you seeking:

Date Available to start work: Tomorrow morning

Total hours available per week: around 30

Monday

Tuesday

Wednesday

Thursday

Friday

Full-Time

Part-Time

Saturday

Sunday

What hours are you available to work? List

hours in each box.
Are you at least 16 years of age?

Yes

No

Are you at least 18 years of age?

Are you legally able to be employed in the U.S.? Yes

Have you ever worked for cottage Inn Pizza Before? Yes

Yes

No

No
No

If yes, Date worked:

Location:

Reason for leaving:

Have you ever been convicted or plead guilty to a felony crime other than a minor traffic violation? (If yes, please explain) Yes

No

List below your most recent employers, beginning with the most recent one.
Company:

Address:

Job Title:

Supervisor:

Date Started:

Date Left:

Salary or Wage: End

Hourly

Phone Number:

Salary or Wage: Start

Weekly

Hourly

Weekly

Yearly

Weekly

Yearly

Yearly

Reason for leaving:

Company:

Address:

Job Title:

Supervisor:

Date Started:

Date Left:

Salary or Wage: End

Hourly

Phone Number:

Salary or Wage: Start

Weekly

Hourly

Yearly

Reason for leaving:

References (Do not list immediate family members)
Name:

Julie Crossman

Phone Number:

Name:
Name:

Phone Number:

How did you hear about us?

Website
Referal:

517-541-5600

Phone Number:

Visiting our store

Other:

Years Known:
Years Known:

Years Known:

Relationship:

Relationship:
Relationship:

(please specify)

(please specify)

Minimum Age Requirement for a delivery driver position is 18. Please answer the following questions if you are applying for a delivery
driver position:
1. Do you have a valid drivers license?

Yes

No

(If yes) Drivers License Number:

Date of Issue:

2. Have you been convicted of or pled guilty to any traffic-related offense within the past five years? Yes

No

3. Have you had your drivers license suspended or revoked, or had your driving privileges modified by a court of law? Yes

NO

4. Please list all states from which you hold or have held a drivers license:

1.

I certify that I have read this application and the information on it is complete and correct. I understand that any omissions or
misrepresentation of information is grounds for dismissal.

2.

I authorize the persons, employers, schools, and organizations listed on this application to give you any information concerning my
employment and other pertinent information they may have, personal and otherwise, and release all parties from all liability and damages that
may result
from furnishing this to you.

Signature Addison

Kimmer

Date 1/21/15