Today's Date: 

Full Name:        Email Address: 
Street Address:   City:   State:   Zip:
Phone with area code (where you can most easily be reached): 
Are you under 18?  Yes    If Yes, your Date of Birth: 

Position(s) Applying For:

Please review the duties of this position as outlined in the job preview (click on the position title above). 

Can you perform the essential functions of this job?  Yes

Availability:

When can you start? 

Are you legally entitled to work in the United States?  Yes
Have you worked at any Fox's Pizza Den before?   Yes
If Yes, please give dates and Location:
How did you learn about this position? 
Do you have a relative working at Fox's Pizza Den?   Yes
If so, what restaurant?

Prior Work Experience (Please list most recent employment first):

Employer:    Phone:
Address:  
Position (duties):
Immediate Supervisor:   May we contact, if still employed? Yes
Starting Pay:   Ending Pay:   Dates: to
Reason for Leaving:

Employer:    Phone:
Address:  
Position (duties):
Immediate Supervisor:   May we contact, if still employed? Yes
Starting Pay:   Ending Pay:   Dates: to
Reason for Leaving:

Employer:    Phone:
Address:  
Position (duties):
Immediate Supervisor:   May we contact, if still employed? Yes
Starting Pay:   Ending Pay:   Dates: to
Reason for Leaving:

Have you EVER been convicted of, or pleaded guilty or no contest to a felony offense? Yes
If Yes, please provide: Date of Birth:    Date of Conviction:
Country/State in which felony occurred:
Facts surrounding the conviction:

Education:

Highest Level Attended:    Years Completed:
Diploma/Degree/Major:

List Special Skills/Training/Licenses or Certifications:

Professional References (Not Relatives or Friends):

Name:   Relationship:   Phone:
Name:   Relationship:   Phone:
Name:   Relationship:   Phone:

Delivery Driver Applicants Only:

If you are employed as a delivery driver by Fox's Pizza Den then you are required to maintain personal Auto Liability insurance at the mandatory state liability limits for the state in which you will be driving. You shall also be solely responsible for maintaining at your cost, such comprehensive and auto collision coverage as you deem necessary to cover your vehicle. We strongly recommend you make appropriate inquiries to assure that such coverage will be effective during the delivery of Fox's Pizza Den products. Fox's Pizza Den is not responsible for, and you assume all risk of, any loss, theft, vandalism or property damage to your vehicle and contents while being used in connection with your employment with Fox's Pizza Den . You will be required to provide Fox's Pizza Den  with a valid copy of your insurance policy or Declaration Page and proof of payment of due premium when you are hired and again upon each renewal. We reserve the right, and you authorize Fox's Pizza Den or its agents, to contact your insurance agent and/or carrier either verbally or in writing, or both, to confirm the type and amount of your coverage and the date through which premiums have been paid. In addition, your Motor Vehicle Report (MVR) will be checked, at the time of application and periodically thereafter, to verify your driving eligibility, and this serves as our authorization to do so. If you are applying for a delivery driver position, we will need your date of birth to run an MVR Report. This information will not be used for any improper purpose. The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age for individuals who are at least 40 years of age.

Date of Birth:
Insurance Company Name:   Policy Exp. Date:
Driver's License Number:   State:   Date Issued:
Have you had at least six months driving experience in the US?  Yes
Have you ever been convicted of a crime involving a motor vehicle, including vehicular homicide or assault?  Yes
In the last 5 years, have you ever received a violation for DUI or open container/chemical test failure/possession of a controlled substance?  Yes
Has your driver's license ever been suspended or revoked?  Yes
If Yes, please explain:

Vehicles Which Will Be Used on the Job:
Make:   Model:   Year:   License #:   State:
Make:   Model:   Year:   License #:   State:

Equal Opportunity Employer: Fox's Pizza Den is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, sexual orientation, political belief, or disability.

     I hereby affirm that the information given by me on this application for employment is complete and accurate. I understand that any falsification or omission either on this application, or otherwise providing false information to the Company will be immediate grounds for dismissal, no matter when the falsification or omission is discovered.

     In connection with this application for employment, I authorize my prior and current employer to provide 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 results from furnishing same to you.  I authorize you to make a thorough investigation of me, which may include obtaining a consumer, credit or criminal report, investigation of my general character, reputation, personal characteristics, employment, education, and criminal record, whichever may be applicable for employment purposes. I understand this investigation may include personal interviews with third parties such as family members, business associates, friends, neighbors, and others with whom I am acquainted. I further understand I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of the nature and scope of the investigation. I also understand that you may, as permitted by law, require me to undergo drug testing in connection with this application for employment and, if hired, during my employment.

MARYLAND APPLICANTS ONLY: Under Maryland law, an employer may not require as a condition of employment that an individual submit to or take a lie detector or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100.

 Electronic Signature.  I hereby acknowledge that I have read and understand the preceding statement by entering and submitting my name below.

Signature:    Date: