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Job Application

1. Employer Information

Employer: 21st Century Pizza
Address: 1221 SW Jefferson St
City/State/ZIP: Portland, Oregon 97201
Telephone: (503) 954-1570

It is the policy of 21st Century Pizza to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

2. Applicant Information







3. Emergency Contact







Full TimePart Time

NoYes


NoYes



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NoYes


NoYes

15. Applicant's Skills

List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and select the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

Skill 1:



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List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held beginning with the most recent, and list and explain any gaps in employment. Add any additional employment information in the corresponding section.









Employer Name:














Additional Employment History:


College/University Name and Address



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NoYes



List any two non-relatives who would be willing to provide a reference for you.

First Person's Name:









19. Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application; or if employment commences, immediate termination.

I authorize 21st Century Pizza to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be "at-will". In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of 21st Century Pizza, except in a specific written contract of employment signed on behalf of the organization by its Owner, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND UNDERSTAND AND AGREE TO ITS TERMS.