Employment Application | Mama Roscoe’s Pizzeria

Applicant Information

First Name

Last Name

Address # and Street

City

State

Zip Code

Email Address

Phone

Date of Application

Available Start Date

Hourly Wage Expectation

How did you hear about Mama Roscoe’s Pizzeria?

Position & Scheduling

7:00 a.m.–4:00 p.m. Prep 10:30 a.m.–4:00 p.m. Crew 4:00 p.m.–10:30 p.m. Crew

Can you work weekends & holidays?

Available to work overtime if needed?

Reliable transportation?

Reminder: Sundays are mandatory for either an AM or PM shift.

Availability

Shift	Mon	Tue	Wed	Thu	Fri	Sat	Sun
AM (10am–4pm)
PM (4pm–11pm)

Personal Information

Applied or worked here before?

18 years of age or older?

Approved to work in the U.S.?

Need job accommodations?

If yes, Accommodations required, Please discribe below

Friends, relatives, or acquaintances working here? ) list names and relationship.)

Ever convicted of a criminal offense (felony or misdemeanor)?

If yes, please state the nature of the crime(s), when and where convicted, and disposition of the case

No applicant will be denied employment solely on the grounds of conviction of a criminal offense. Relevant details and surrounding circumstances may be considered as allowed by law.

Previous Employment

Most Recent Job

Name of Business

Dates Employed

Job Title

Supervisor Name

Employer Address

City, State, Zip

Employer Telephone

Reason for Leaving

2nd Most Recent Job

Name of Business

Dates Employed

Job Title

Supervisor Name

Employer Address

City, State, Zip

Employer Telephone

Reason for Leaving

3rd Most Recent Job

Name of Business

Dates Employed

Job Title

Supervisor Name

Employer Address

City, State, Zip

Employer Telephone

Reason for Leaving

Skills, Education, Military, & References

Job Skills / Qualifications

License / Certifications

Food Certification Alcohol Certification (Age Permitted)

Education and Training

High School Name

Location

Year Graduated

Degree Earned

College / University Name

Location

Year Graduated

Degree Earned

Vocational / Specialized Training

Location

Year Graduated

Degree Earned

Military

Member of the Armed Services?

Branch

Rank at Discharge

Years Served

Military skills that would be an asset for this position

References

Personal Reference Contact Information

Professional Reference Contact Information

At-Will Employment & Signature

The relationship between you and Mama Roscoe’s Pizzeria is referred to as employment at will. This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or Mama Roscoe’s Pizzeria. No representative of Mama Roscoe’s Pizzeria has authority to enter into any agreement contrary to the foregoing employment-at-will relationship except in a written statement signed by both parties.

I understand and acknowledge the at-will employment statement above.

Applicant Signature (typed full name)

Signature Date

Additional Notes