Pizza Systems, Inc. P.O. Box 2457 Binghamton, NY 13902
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GENERAL INFORMATIONTODAY’S DATE: ______
POSITION APPLIED FOR: ______RATE DESIRED: $______hrYOU CAN START: ______
NAME: ______
(last)(first)(middle initial)
ADDRESS: ______
(street)(city)(state) (zip code)
TELEPHONE NUMBER: (______) ______
Have you been employed by Nirchi’s Pizza before? YES NO
Location: ______From: ____/____ to ____/____
Do you currently have a family member employed by Nirchi’s Pizza? YES NO
Location: ______
Have you been convicted of a felony in the last five (5) years? YES NO
If yes, please explain: ______
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SCHEDULE
Type of employment desired:Full-time Part-time SeasonalShifts desired:Day Night Any
Are you willing to work weekends? Yes NoAvail:| Mon | Tue | Wed | Thu | Fri | Sat | Sun |
From:______
To:______
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MILITARY INFORMATION (If you served in the military, you will be asked to provide a copy of form DD-214)
Have you ever served in the United States Armed Forces? Yes NoBranch: ______Years: ______
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EDUCATION BACKGROUND
High School: ______Did/Have you graduate(d)? YES NO GED Are you still enrolled? YES NO
College: ______Did/Have you graduate(d)? YES NO Are you still enrolled? YES NO
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(APPLICATION CONTINUES ON OTHER SIDE)
EMPLOYMENT HISTORY
Employer: ______Phone: (______) ______Dates employed: ____/____to____/____
Address: ______
(Street)(City)(State) (Zip code)
Job title: ______Starting rate/salary: $______Final rate/salary: $______
Immediate supervisor & title: ______May we contact supervisor for reference? YES NO
Reason(s) for leaving: ______
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Employer: ______Phone: (______) ______Dates employed: ____/____to____/____
Address: ______
(Street)(City)(State) (Zip code)
Job title: ______Starting rate/salary: $______Final rate/salary: $______
Immediate supervisor & title: ______May we contact supervisor for reference? YES NO
Reason(s) for leaving: ______
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Employer: ______Phone: (______) ______Dates employed: ____/____to____/____
Address: ______
(Street)(City)(State) (Zip code)
Job title: ______Starting rate/salary: $______Final rate/salary: $______
Immediate supervisor & title: ______May we contact supervisor for reference? YES NO
Reason(s) for leaving: ______
======+======REFERENCES
Name: ______Phone: (______) ______Relation: ______
Name: ______Phone: (______) ______Relation: ______
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AUTHORIZATION
I hereby certify that the information contained in this application is true and correct to the best of my knowledge and agree to have any information verified by Pizza Systems, Inc. dba Nirchi’s Pizza; unless I have indicated to the contrary.
Nirchi’s Pizza is an equal opportunity employer and does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on a basis prohibited by local, state, or federal law.
This application is current for only thirty (30) days. At the end of this time, if I have not heard from the employer and still want to be considered for employment, it will be necessary for me to fill out a new application.