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SINCE 1971

Employment Application

PIZZERIA RISTORANTE + SPORTS LOUNGE

PRE-EMPLOYMENT QUESTIONNAIRE EQUAL OPPORTUNITY EMPLOYER

www.florentinespizza.com (616) 455-2230

___________________________________ DATE

PERSONAL INFORMATION: FULL NAME

SOCIAL SECURITY NUMBER

PRESENT ADDRESS

CITY

PHONE NUMBER

STATE

ZIP CODE

MOBILE/ALTERNATE

E-MAIL

IF YOU ARE UNDER 18 YEARS OF AGE, CAN YOU PROVIDE A WORK PERMIT? q YES q NO

DRIVER LICENSE NUMBER/STATE

EMPLOYMENT DESIRED: POSITION

DATE YOU CAN START

SALARY DESIRED

ARE YOU EMPLOYED NOW? q YES q NO

ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?

IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? q YES q NO

q YES q NO

EVER APPLIED TO FLORENTINE’S BEFORE?

IF SO, WHEN?

REFERRED BY

q YES q NO TYPE OF EMPLOYMENT DESIRED q FULL TIME

q PART TIME

HAVE YOU EVER PLEADED GUILTY, NO CONTEST OR BEEN CONVICTED OF A CRIME?* q SEASONAL

IF YES, GIVE DETAILS: *Answering yes to the above question does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

AVAILABILITY: (CANDIDATES MUST BE AVAILABLE TO WORK AT LEAST 3 SHIFTS PER WEEK) MONDAY q AM

q PM

q OPEN q N/A

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

q AM

q AM

q AM

q AM

q PM

q OPEN q N/A

q PM

q OPEN q N/A

q PM

q OPEN q N/A

q PM

q OPEN q N/A

SATURDAY

SUNDAY

q AM

q AM

q PM

q OPEN q N/A

q PM

q OPEN q N/A

ARE YOU AVAILABLE TO WORK HOLIDAYS? IF NOT, PLEASE INDICATE WHICH HOLIDAYS YOU ARE NOT ABLE TO WORK:

EDUCATION: NAME AND LOCATION OF SCHOOL

YEARS ATTENDED

DID YOU GRADUATE?

SUBJECTS STUDIED

HIGH SCHOOL

COLLEGE

TRADE/CAREER SCHOOL

SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS:

_________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________


FORMER EMPLOYERS: (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH THE LAST ONE FIRST) DATE MONTH/YEAR

NAME & ADDRESS OF EMPLOYER

SALARY

POSITION

REASON FOR LEAVING

FROM

TO

FROM

TO

FROM

TO

FROM

TO

REFERENCES: (PROVIDE NAMES OF THREE PERSONS NOT RELATED TO YOU WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.) NAME

PHONE NUMBER

BUSINESS

YEARS KNOWN

AUTHORIZATION:

“I certify that the facts contained in this application are true and complete to the best of my knowledge, and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I release the company from all liability for any damage that may result from utilization of such information. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.” DATE ____________________________ SIGNATURE _______________________________________________________________

Florentine’s Pizzeria Ristorante + Sports Lounge is an Equal Opportunity Employer. 4261 Kalamazoo, Grand Rapids, MI 49508 • (616) 455-2230

Florentine employment application  

Please attach a resume, if you have one.

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