Employment | Mama Roscoe’s Pizzeria

Applicant Information

Please print clearly and complete every section.

Last Name

First Name

Address # and Street

City, State, Zip Code

Email Address

Phone

Date of Application

Position & Availability

Employment Position Applying For

Shift Interest

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

Can you work weekends & holidays?

How did you hear about Mama Roscoe’s Pizzeria?

Available to work overtime if needed?

Date available to start

Reliable transportation to and from work?

Hourly wage expectations

Personal Information

Have you ever applied to or worked for Mama Roscoe’s before?

If yes, dates and location

Friends, relatives, or acquaintances working here?

If yes, name(s) and relationship

Are you 18 years of age or older?

Are you a U.S. citizen or approved to work in the United States?

Do you have any condition which would require job accommodations?

If yes, describe accommodations required

Have you ever been convicted of a criminal offense?

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

Note: No applicant will be denied employment solely because of a criminal conviction. Relevant details and circumstances may be considered.

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

Job Skills / Qualifications

Please list the skills and qualifications you possess for this position

ADA: Mama Roscoe’s Pizzeria complies with the ADA and considers reasonable accommodations that may be needed for eligible applicants or employees.

Education and Training

High School

Name

Location (City, State)

Year Graduated

Degree Earned

College / University

Name

Location (City, State)

Year Graduated

Degree Earned

Vocational School / Specialized Training

Name

Location (City, State)

Year Graduated

Degree Earned

Military

Are you a member of the Armed Services?

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve?

What military skills would be an asset for this position?

References

Please provide 2 personal and professional references.

Reference, Personal Contact Information

Reference, Professional Contact Information

At-Will Employment

The relationship between you and Mama Roscoe’s Pizzeria is employment at will. This means employment may be terminated at any time, for any reason, with or without cause or notice, by you or Mama Roscoe’s Pizzeria. No oral or written statements can alter that status except a written statement signed by you and an authorized company representative.

Applicant Signature

Date