Pizza Works

 14130 Juania DR NE STE 109

Bothell, WA 98011-4927

                        Employment Application                                                                                                            (425) 821-1300

Applicant Information

Full Name

Last

First

M./I.

Date of Birth

Address

Street Address

Apartment/Unit

Phone Number

City

State

Zip Codes

Date Available:

Social Security #:

Drivers License or Passport #:

Position Applied for:

Are you a citizen of the United States?

YES

NO

If no, are you authorized to work in the U.S.?

YES

NO

Have you ever worked for this company?

YES

NO

If so, when?

Have you ever been convicted of a felony?

YES

NO

If yes, explain:

Education

High School:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

College:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

Other:

Address:

From:

To:

Did you graduate?

YES

NO

Degree:

References

Please list two personal references.

Full Name:

Relationship:

Company:

Phone:

(         )

Address:

Full Name:

Relationship:

Company:

Phone:

(         )

Address:

Previous Employment

Company:

Phone:

(         )

Address:

Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:

Phone:

(         )

Address:

Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:

Phone:

(         )

Address:

Supervisor:

Job Title:

Starting Salary:

$

Ending Salary:

$

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Military Service

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Drivers Information

Drivers License Number:

Have you received any traffic tickets or had any automobile accidents in the last 3 years?

YES

NO

If yes, explain:

Auto Insurance Company:

Policy #:

Disclaimer and Signature

If I am applying for a Driving Position, I understand and I will need to bring a copy of my driving record to the interview or if the manager agrees, sign a consent form for Pizza Works, Inc. to request my driving records from the Department of Licensing ($7.00 fee and 2 weeks clearance required).

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature

Date