Employment

Blackjack Pizza is an Equal Opportunity Employer. Various Federal, State, and Local laws prohibit discrimination on account of race, color, religion, age, national origin, disability or veteran status. It is this Company’s policy to comply fully with these laws, as applicable, and information requested on this application will not be used for any purpose prohibited by law. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, age, national origin, handicap, or veteran status.

Date

Personal Info

Last Name*

First Name*

Middle Name

Present Address*

Street Address Address Line 2 City State ZIP Code

Is this also your Permanent Address?*

Permanent Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Are you 18 years of age or older?*

Date of Birth*

Are you legally able to work in the United States?*

Employment Desired

Which store would you like to work at?*

Select the location from the drop down list.

Position*

Salary Desired*

Date you can start*

Are you employed now?*

May we inquire of your present employer?*

Have you ever applied to this company before?*

Where?*

When?*

Work Experience

Note: Start with most recent position, furnish dates (month and year) and explanations for each period of unemployment of one month or more.

Most Recent Employer

Name of Employer*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Position*

Start Date*

Month and Year

Leave Date*

Month and Year

Reason for leaving*

Second Most Recent Employer

Name of Employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Position

Start Date

Month and Year

Leave Date

Month and Year

Reason for leaving

Other Employer

Name of Employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Position

Start Date

Month and Year

Leave Date

Month and Year

Reason for leaving

Other Employer

Name of Employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Position

Start Date

Month and Year

Leave Date

Month and Year

Reason for leaving

Please explain any periods of unemployment of one month or more

Start Date	End Date	Explanation

References

List up to 3 people not related to you, whom you have known at least one year.

References*

Name	Address	Phone	Years Acquainted

Delivery Drivers Only

Are you applying to be a Delivery Driver?*

A copy of the following is required from each applicant:
a) Driver’s License;
b) Vehicle Registration;
c) Auto Liability Insurance Policy (Vehicle only)
Please bring these items to your interview.

Have you ever been convicted of a crime involving a motor vehicle, including vehicular homicide or assault?*

Please explain:*

In the last 5 years, have you ever received a violation for DUI or open container/chemical test failure/possession of a controlled substance?*

Please explain:*

Has your driver’s license ever been suspended or revoked?*

Please explain:*

The information I have supplied is complete and accurate. I authorize the Company to verify this information now and in the future, and understand that I may be terminated at any time if my driving record does not meet Company requirements.

If I am employed as a delivery driver by the Company, I also agree to maintain, at my cost, personal auto liability insurance at the mandatory state liability limits for the state(s) in which I will be driving. I agree to renew my driver’s license before expiration. I understand that Blackjack Pizza and the Company are not responsible for damage to my vehicle, and I agree to have continuously in force auto liability insurance that will cover my vehicle while working here. I agree that it is my responsibility to consult with my insurance agent to maintain adequate insurance.

I UNDERSTAND THAT BLACKJACK PIZZA AND THE COMPANY DO NOT WANT ME TO EVER SPEED OR DRIVE RECKLESSLY IN ANY WAY. I WILL REPORT ANY INSTRUCTIONS TO DO OTHERWISE TO THE BLACKJACK PIZZA CORPORATE OFFICE.

I AGREE TO OBEY THE FOLLOWING POLICIES WHILE WORKING:

To always drive courteously, safely, and follow defensive driving techniques while obeying all laws.
To notify the Company if there is any change in my car insurance.
To notify the Company if my driving privileges are restricted, suspended, or revoked, and in the event I receive a ticket, on or off the job.
To always use my seat belt while working here and keep my radio/music system to a volume level my supervisor finds acceptable at all times.
To be employed here as a driver it is up to me to supply a clean, safe, dependable vehicle with proper insurance. I realize that if I am employed as a driver, my employment can be terminated if my car is not in proper working order.
To never allow anyone else to ride with me while working, unless instructed by my supervisor.
To never eat or drink while driving.
To discuss with my supervisor any incident involving a vehicle that happens while working, no matter whose fault, and whether or not there were any injuries.

Legal Agreements and Signature

I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF I AM EMPLOYED, ANY OMISSION OR FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES 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 ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.

I UNDERSTAND THAT NOTHING IN THIS EMPLOYMENT APPLICATION, IN COMPANY STATEMENTS OF PERSONNEL POLICIES, OR IN MY COMMUNICATION WITH ANY EMPLOYEE OR OFFICIAL IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT BETWEEN THE COMPANY AND ME, AND THAT MY EMPLOYMENT WITH THE COMPANY IS ENTERED INTO VOLUNTARILY, AND THAT I MAY RESIGN AT ANY TIME. SIMILARLY, MY EMPLOYMENT MAYBE TERMINATED WITH OR WITHOUT CAUSE AT ANY TIME WITHOUT PRIOR NOTICE.

Signature*

Today's Date*

ONLINE EMPLOYMENT APPLICATION

Personal Info

Employment Desired

Work Experience

Most Recent Employer

Second Most Recent Employer

Other Employer

Other Employer

References

Delivery Drivers Only

Legal Agreements and Signature