Personal Information First name *
Last name *
Email *
How did you hear about this position?
Position/Interest Position
Salary requirements (per hour/week)
Hours/days available
Date available to start
Have you applied to work here before? If so, list date.
Have you worked here before? If so, list start & end dates.
Reason for leaving
Education Please list name of institution, address, and years completed/degree obtained.
High school
College
Licenses/certificates
Work skills
Work History Please list your two most recent employers, beginning with your current or most recent.
Employer 1: name
Employer 1: role
Employer 1: supervisor
Employer 1: phone number
Employer 1: beginning & ending dates
Employer 1: reason for leaving
Employer 2: name
Employer 2: role
Employer 2: supervisor
Employer 2: phone number
Employer 2: beginning & ending dates
Employer 2: reason for leaving
Personal References Please include name, address, telephone number, and number of years known for each reference. Do not include relatives as references.
Reference 1
Reference 2
Applicant Acknowledgment I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that material misrepresentations or omissions may result in withdrawal of an employment offer or termination of employment.
I authorize Cooper Hill Pizzeria to contact my previous employers and references to verify information relevant to my qualifications.
I understand that, depending on the position, employment may be subject to satisfactory background checks, driving-record checks, credit checks and/or drug and alcohol testing, as permitted by applicable law. I agree to provide any additional authorizations required for these screenings.
I understand that, if employed, I will be expected to comply with company policies and procedures.
I understand that employment with Cooper Hill Pizzeria is at will, meaning either I or the company may terminate the employment relationship at any time, with or without notice or cause, subject to applicable law.
I acknowledge that I have read and understand the statements above.
Your full name *
Date *