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Mt. Vernon:
(812) 838-9850
1244 Main St, Mt Vernon, IN 47620
|
Evansville:
(812) 773-3195
3848 North First Avenue, Evansville, IN 47710
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Employment Form
Apply online below or download our employment form
Download Form
Location you are applying for:
Evansville IN
Mt.Vernon IN
Name (last)
Name (first)
{middle initial)
Cell #
Address (mailing)
City
State
Zip Code
Other Tel #
E-mail
Emergency Contact
Emergency Contact #
Are you 16 years of age or over (proof of age or work permit may be required)?
Yes
No
Are you legally able to work in this country?
Yes
No
Employment Desired
What type of position are you seeking (you may check more than one box):
Part-time
Full-time
Seasonal
Temporary
Position
Salary Desired
Are you employed now:
Yes
No
If so may we inquire of your present employer?
Yes
No
Ever applied to DiMaggio' Pizza?
Yes
No
When:
Where:
Availability
Date able to start work
Total hours available per week
Tuesday
Tuesday
Wednesday
Wednesday
Thursday
Thursday
Friday
Friday
Saturday
Sunday
General Information
Special Skills/Training
Certifictions (include certificate number)
Work History
List below the last four employers, starting with your most recent
First Employer
From
To
Name
Address
City
State
Zip Code
Phone
Salary
Position
Reason for Leaving
Second Employer
From
To
Name
Address
City
State
Zip Code
Phone
Salary
Position
Reason for Leaving
Third Employer
From
To
Name
Address
City
State
Zip Code
Phone
Salary
Position
Reason for Leaving
Forth Employer
From
To
Name
Address
City
State
Zip Code
Phone
Salary
Position
Reason for Leaving
Education History
High School
School Name
School Location
Years Attended
Degree/Courses
College
School Name
School Location
Years Attended
Degree/Courses
Trade School
School Name
School Location
Years Attended
Degree/Courses
References
(List names of persons not related to you, whom you have known at least 1 year)
Name
Phone
Relation
Business
Years Known
Name
Phone
Relation
Business
Years Known
Name
Phone
Relation
Business
Years Known
Authorization
“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds to 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 release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. 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. I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.” IN compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document upon hire.
By checking this box, I agree that the above form is correct and all information is true.
Date
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