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APPLICATION FOR EMPLOYMENT
Manco & Manco considers qualified applicants for employment without regard to race, color, creed, religion, sex, national origin, age, marital status, ancestry, sexual orientation, medical condition or disability, or any other basis prohibited by law.
Date

Month Day Year
Date
PERSONAL INFORMATION
First Name *
Middle Name
Last Name *
Address *
City *
State *
Zip *
Home Phone *
Cell Phone
Email Address *
Social Security Number (please do not include the dashes) *
Are you 18 or older? *

Yes No
If you are under 18 years of age, can you furnish a work permit? *

Yes No
If hired, do you have a reliable means of transportation to get to work? *

Yes No
Describe

EDUCATION/TRAINING
Highest Level Completed: *

Less than High School Diploma High School School Diploma Diploma/GED Associate"s Degree Bachelor"s Degree Master"s Degree Ph.D.
Name of High School
Address
Major
# Years Attended
Name of College/University
Address
Major
# Years Attended
Other Training/Education
Address
Major
# Years Attended

WORK HISTORY
Please list all current/previous employers, beginning with most recent
Current/Last - Employer"s Name *
Telephone Number *
Address *
Supervisor"s Name *
Position Held
Dates of Employment (From - To)
Hourly Pay Rate
Reason for Leaving
May we contact?

Yes No
Describe your job responsibilities
Previous- Employer"s Name
Telephone Number
Address
Supervisor"s Name
Position Held
Dates of Employment (From - To)
Hourly Pay Rate
Reason for Leaving
May we contact?

Yes No
Describe your job responsibilities
Previous - Employer"s Name
Telephone Number
Address
Supervisor"s Name
Position Held
Dates of Employment (From - To)
Hourly Pay Rate
Reason for Leaving
May we contact?

Yes No
Describe your job responsibilities

PERSONAL
Have you ever been known by any other name(s)? *

Yes No
If yes, what names?
Can you perform the tasks of the position for which you are applying with or without a reasonable accommodation?

Yes No
If no, please explain
Are you legally entitled to work in the United States? *

Yes No
If you are hired by Manco & Manco, The Immigration Reform Act of 1986 requires you to provide certain information, including date of birth and country of origin, and to attest to your employment eligibility. In addition, you will be required to produce documents establishing your identity and work authorization.
Please describe any skills, training or qualifications you have which are relevant to the job you are applying for (i.e., computer skills, restaurant training):

EMPLOYER/PROFESSIONAL REFERENCES
Name
Title
Phone number (s)
Organization
Address
Name
Title
Phone number (s)
Organization
Address
Name
Title
Phone number (s)
Organization
Address

PLEASE READ CAREFULLY
APPLICANT’S CERTIFICATION/AT-WILL EMPLOYMENT: I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements shall be considered cause for dismissal. I also understand that if I am hired for employment, I am required to abide by the rules and policies of Manco & Manco. I further agree to immediately notify Manco & Manco if I should be convicted of a crime while my job application is pending or during my employment, if hired. I also understand that a background check may be performed on me as set forth in the separate document entitled Background Check Disclosure and Authorization for Release of Records that is enclosed separately with this application for my review and signature. I release, indemnify and hold harmless Manco & Manco from and against any and all liability which might result from making such an investigation. I further understand that this employment application and any other organization documents are not contracts of employment, and that any individual that is hired may voluntarily leave employment, and may be terminated by the employer at any time for any reason. I understand that any oral or written statements to the contrary are expressly disavowed and should not by relied upon by any prospective or existing employee. I also understand that the use of this application does not necessarily indicate that there are any positions open and does not obligate Manco & Manco in any way. It is understood employment is predicated on passing any applicable pre-employment examinations.
Signature (please use your initials) *
Date *

Month Day Year
Date

EMPLOYMENT REFERENCE RELEASE:
I authorize my prior and current employer to release all information (including opinion information) regarding my employment with them. I hereby release and hold harmless any individual and company which is providing this information to Manco & Manco from any legal liability for any damages that may result from the disclosure of this information.
Signature (please use your initials) *
Date *

Month Day Year
Date

BACKGROUND CHECK DISCLOSURE & A UTHORIZATION FOR RELEASE OF RECORDS
IMPORTANT - PLEASE READ AND SIGN THE FOLLOWING: I am applying for employment with Manco & Manco Pizza. I acknowledge that I have been notified by Manco & Manco Pizza that it may obtain my consumer report in connection with this application and, if I am offered employment, may obtain consumer reports during my employment. A “consumer report” is defined as any written, oral or other communication of any information by a consumer reporting agency bearing on a consumer’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. This information may include, but not be limited to: verification of identification and/or social security number; checks of criminal history, if any; and verification of any licenses held. I understand that this information may be used to evaluate me for possible and/or continued employment. The Fair Credit Reporting Act entitles me to know if an adverse employment decision is made based on this information obtained from a Consumer Reporting Agency. If any adverse employment decision is made based on this information, I will be advised. I will also be given the name of the agency or source which provided the information, a copy of the information and a summary of my rights under the Fair Credit Reporting Act. By my signature below, I authorize Manco & Manco Pizza to obtain a consumer report from any consumer reporting agency in order to consider me for possible and/or continued employment.
Signature (please use your initials) *
Date *

Month Day Year
Date
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