The Basics

Personal Information

Name (last, first, middle):
Current address:

City, State, Zip:
Phone number:
Email address:

Location and Shift Availability

Locations I prefer:
Shifts I prefer
Monday:	day	night
Tuesday:	day	night
Wednesday:	day	night
Thursday:	day	night
Friday:	day	night
Saturday:	day	night
Sunday:	day	night
Shifts I am unavailable
Monday:	day	night
Tuesday:	day	night
Wednesday:	day	night
Thursday:	day	night
Friday:	day	night
Saturday:	day	night
Sunday:	day	night

On the Job

You must be at least 16 years old to work at Pagliacci Pizza, and at least 21 years old to work as a delivery driver or in a position to serve alcohol.

I am:

Under 18
18-20
21 or over

The position I am applying for is:

Crew or Counter Person
Customer Service Representative
Delivery Driver
Manager

I intend to work here hours a week

for an indefinite time
until

and expect to be paid .

While employed here, I:

do	do not	intend to have another job and/or attend school.
have	have not	previously worked for Pagliacci Pizza or previously applied for a job at Pagliacci Pizza.
do	do not	have relatives or friends who work at Pagliacci Pizza or previously applied for a job at Pagliacci Pizza.

Details about my response:

Employment History

The number of jobs I have had

in the last 12 months is
in the last 24 months is
in the last 36 months is
in the last 60 months is

Most Recent Employer

Company name:
Supervisor:
Address:
Phone:
Job title/duties:
From:	Month (1-12) Year
To:	Month (1-12) Year
Hours/week:
Eligible for rehire?	Yes No
Can we contact?	Yes No
Reason for leaving:

Second Most Recent Employer

Company name:
Supervisor:
Address:
Phone:
Job title/duties:
From:	Month (1-12) Year
To:	Month (1-12) Year
Hours/week:
Eligible for rehire?	Yes No
Can we contact?	Yes No
Reason for leaving:

Third Most Recent Employer

Company name:
Supervisor:
Address:
Phone:
Job title/duties:
From:	Month (1-12) Year
To:	Month (1-12) Year
Hours/week:
Eligible for rehire?	Yes No
Can we contact?	Yes No
Reason for leaving:

Other Information

Schools

High school:
City, State:
# of years:
College:
City, State:
# of years:
Degree (yes/no, type)
Other school:
City, State:
# of years:
Degree (yes/no, type)

Personal Reference

Name:
Relationship:
Has known me since:
Address:
Home phone #:
Work phone #:

Miscellaneous

What was it that made you apply for a job at Pagliacci at this time?

What is your favorite type of pizza?

Other places where I am currently applying for work and the jobs for which I am applying are:

I'd also like to tell you:

Miscellaneous

Click the Submit button to submit your application.