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

Applicant Full Name:

Email:

Home Address:

City/State/ZIP:


Number of Years at this Address:


Daytime Phone:


Mobile Phone:


Evening Phone:


Social Security Number:


Driver's License (State/Number):

3. Emergency Contact

Who should be contacted if you are involved in an emergency?



Relationship to you:



Address:



City/State/ZIP



Daytime Phone:



Evening Phone:

4. Job Position Applied For:

Time Commitment Interested:
Full TimePart Time

5. Salary Desired (hourly pay):

6. Who referred you to our company, or how did you find out about this job opportunity?

Do you have any friends or relatives who work here? If yes, please list here:

7. Have you applied to our company previously?

NoYes

If so when?

8. Are you at least 18 years old?
NoYes

9. How will you get to work?



10. Are you willing to work any shift, including nights and weekends?
YesNo

If no please state limitations:



11. If applicable, are you available to work overtime?
YesNo

12. If you are offered employment, when would you be available to begin work?



13. If hired, are you able to submit proof that you are legally eligible for employment in the United States?
NoYes

14. Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?
NoYes

What reasonable accommodation, if any, would you request?

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:




Years of experience:



Ability:
12345

Skill 2:



Years of experience:



Ability:
12345

Skill 3:



Years of experience:


Ability:
12345

16. Applicant Employment History

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.


Most Recent or Current Job Information:
Employer Name:


Supervisor Name:


Address:


City/State/Zip:


Job Duties:


Reason for Leaving:


Start and End Dates of Employment:

Employer Name:


Supervisor Name:


Address:


City/State/Zip:


Job Duties:


Reason for Leaving:


Start and End Dates of Employment:





Employer Name:


Supervisor Name:


Address:


Job Duties:


Reason for Leaving:


Start and End Dates of Employment:

Additional Employment History:



17. Applicant's Education and Training

College/University Name and Address



Did you receive a degree?
NoYes

Other Training (graduate, technical, vocational):



Please indicate any current professional licenses or certifications that you hold:



Awards, Honors, Special Achievements:



Military Service:
NoYes

Military Branch:



Specialized Training:



18. References

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

First Person's Name:


Address:


City/State/ZIP:


Telephone:


Relationship:


Second Person's Name:


Address:


City/State/ZIP:


Telephone:


Relationship:

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.

APPLICANT SIGNATURE:



DATE:

I accept these terms

Submit: