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
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