Employment ApplicationIf you are applying to Tremont House of Pizza, please fill in all fields in this form. *All fields are required in this form in order to submit to us."*" indicates required fieldsStep 1 of 520%You Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone number*Cell phone numberEmail address* Are you at least 18 years old?*YesNoWhat date are you available to start?*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What is your minimum wage requirement?*What position are you applying for?**Delivery Driver applicants must answer the section titled: Driver's License and Driving InformationIf you are hired, what days and times of day can you work?*Are you capable of lifting 25lbs or less?*YesNoAre you able to stand for 2-3 hours at a time?*This position may require that you are on your feet for extended periods of time.YesNoAre you taking any medication or have any medical conditions that could impact your safety or the safety of others while on the job?* Yes NoThree characteristics that best describe you:*1. 2. 3. Why do you want to work at Tremont House of Pizza?*Please list any special interests, hobbies and skills:*Additional information you would like us to know about your values, desires and work ethic:*Have you ever been convicted of a felony or misdemeanor?*YesNoIf yes, please explain:*Driver's License & Driving Information*REQUIRED ONLY if you are applying for the delivery driver position.Do you have a valid driver's license? Yes NoWhat state is your driver's license issued from?Has any license, permit or privelege ever been suspended or revoked? Yes NoIf Yes, why did your license or permit get revoked?Have you been involved in a traffic accident in the past 5 years? Yes NoIf Yes, what date did the last accident take place?Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Where there any injuries in this accident? Yes NoWhere there any fatalities in this accident? Yes NoHave you had any traffic convictions and/or forfeitures in the past 5 years (other than parking violations?)Location: Date: Charges: Penalty: If yes, please explain?Employer 1 Information ( most recent employer)Employer 1 Company Name* Employer 1 - Address*Please fill in all information about your most recent employer. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer 1 - Phone Number*Employer 1 -How did you end your employment with this company?* I resigned I was terminated I am currently still employed here I am a seasonal employee OtherEmployer 1- Please state reason for your employment ending*Employer 1 - Job title*Employer 1 - Starting pay*Employer 1 - Ending pay?*Employer 1 - Start date?*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employer 1 - End date?*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employer 1 - Describe your duties at this job.*Employer 1 - Supervisor's name?*Employer 1 - Supervisor's phone number?*Employer 2 - (Second most recent)Employer 2 Company Name* Employer 2 - Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer 2 - Phone Number*Employer 2 - How did you end your employment with this company?* I resigned I was terminated I am currently still employed here I am a seasonal employeeEmployer 2 - Please state reason for your employment ending*Employer 2 - Job title?*Employer 2 - Starting pay?*Employer 2 - Ending pay?*Employer 2 - Start date?*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employer 2 - End date?*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employer 2 - Describe your duties at this job.*Employer 2 - Supervisor's name?*Employer 2 - Supervisor's phone number?*Do you have any other past employment to list?* Yes NoIf yes, please use the box below to list employer names/phone numbers:EducationHigh School(s)*Did you graduate from High School?* Yes No I got my GED I'm still attendingPlease check the box below acknowleging that you understand our drug policy.* I understand that Tremont House of Pizza is a DRUG FREE FACILITY AND WORK PLACE.Signature / Disclosure SectionPlease read and acknowledge at the bottom.*The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history, financial, criminal, credit and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer personality profile tests and verify my back ground. A criminal record or sentience is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment and I agree to submit to a medical evaluation, if required. In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigative consumer report. In exchange for the consideration of my employment application by the company, I hereby release and forever discharge the company (including its directors, officers, employees and agents) and my past and/or present employers (their directors, officers, employees and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize persons to answer all questions asked concerning my ability, character, reputation and previous employment record. I understand that if my application is accepted that employment with this company at all times is employment "at will”. It is further understood that this “at will” relationship may not be changed by any written document, verbal statements, or by conduct unless such change is specifically acknowledged by an authorized executive of the company. I further understand that my “at will” employment may be terminated at any time by myself or the company and includes no guarantee, contract or promise of employment for any specific length of time. I understand that the first two weeks with Tremont House of Pizza is considered a trial period, and that my official start date will be after this period. In the third week of work with Tremont House of Pizza., I will have a review with the co-owners to determine any improvements to my performance deemed necessary, my rate of pay, and anything else the owners feel is pertinent to my success as an employee. I further understand that the first ninety (90) days of employment is a new hire introductory period. I understand and acknowledge that what I have submitted it true and complete. I agree and understand the terms of employement at Tremont House of Pizza.Signature*I understand that by agreeing to the above terms and typing my name here that this is my digital signature.PhoneThis field is for validation purposes and should be left unchanged.
