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Application for Employment
Pagliai's Pizza
(This is a Pre-employment Questionnaire. Pagliai's is an Equal Opportunity Employer)
Date:    
Personal Information
Name:
(Last, First, Middle) 		 
Present Address:
(Street, City, State, Zip)		 Are you 18 years or older? Yes No
Permanent Address:
(Street, City, State, Zip) 		Email Address: (required)
Phone No.:
Are you prevented from lawfully becoming employed in this country because of visa or immigration status? Yes No
Employment Desired
Position: Date you can start: Salary Desired:
Are you employed now?
Yes No
If so may we inquire of your present employer?
Ever applied to this company before? Where? When?
Referred by:
Education
Name & Location of School
*No of Years Attended
*Did You Graduate?
Subjects Studied
Grammar School
High School
College
Trade, Business or Correspondence School
General
Subjects of special study or research work:
Special Skills:
Activities: (civic, athletic, etc.):
(Exclude organizations, the Name of which indicates the race, creed,sex,age,marital status,color or nation of origin of its members)
U.S. Military or Naval Service: xxRank:
Present Membership in National Guard or Reserves:
Former Employers (List Below Last Three Employers, Starting With Last One First)
Date
Month/Year
Name & Address of Employer
Salary
Position
Reason for Leaving
F
T
F
T
F
T
F
T
Which of these jobs did you like the best?
What did you like most about this job?
References (Give the Names of Three Persons Not Related to You, Whom You Have Known At Least One Year.)
Name
Address
Business
Years Acquainted
1
2
3
In Case of Emergency Notify:
Name
Address
Phone No.
"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.
In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the forgoing."
Date:
Electronic Signature:
*This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.
This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. This Application for Employment Form is sold for general use throughout the United States. TOPS assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law.