Welcome to Mary's Pizza Shack!

Please select location preference:

* Required Fields

PERSONAL INFORMATION:

*First Name:

Middle:

*Last:

Present Address:

*Street:

*City:

*State:

*Zip:

Permanent Address:
Leave this blank if same as above

Street:

City:

State:

Zip:

*Phone # where you can be reached:	*Are you 18 years or older?: YES: NO:
*Email address:

EMPLOYMENT DESIRED:

Position:

Date you can start:

Salary desired:

If not sure, leave blank

Have you ever applied to this company before?

YES: NO:

Where?

When?

*Are you employed now: YES: NO:

If so, may we request information from your present employer?

YES: NO:

*How did you learn about us?

EDUCATION:

EDUCATION:	Name & location of school:	Years attended?	Did you graduate?	Subjects Studied?
Grammar School:			Yes: No:
High School:			Yes: No:
College:			Yes: No:
Trade, Busines or Correspondence School			Yes: No:

PREVIOUS EMPLOYERS:

*Employer:	*Duration of employment:	*Position:
*Reason for leaving:

Employer:	Duration of employment:	Position:
Reason for leaving:

REFERENCES: Give the names of three (3) persons not related to you, whom you have known at least one year.

(1) *Name:

*Address:

*Occupation:

*Years Acquainted:

(2) *Name:

*Address:

*Occupation:

*Years Acquainted:

(3) *Name:

*Address:

*Occupation:

*Years Acquainted:

PHYSICAL RECORD:

Do you have any physical limitations that preclude you from performing any work for which you are being considered?

YES: NO:

If "YES", what can be done to accommodate your limitations?

LAST QUESTION: Why should Mary's Pizza Shack hire you?