Pizza Ranch Application Form

Street Address *

Apartment Number

Phone Number *

Email Address *

Name of teacher/counselor to contact as a reference *

Department

What position are you applying for? *

Type of position you are seeking:

Full - Time Part - Time

Total hours available per week *

Date available to start work *

Please list the times you are available to work each day (e.g. "9:00am-3:30pm" or "after 3:30pm"):

Are you 16 years old or older?:

Yes No

Are you 18 years old or older?:

Yes No

Are you legally able to be employed in the U.S?:

Yes No

Are you on layoff and subject to recall?:

Yes No

Have you ever worked at Pizza Ranch before?:

Yes No

Still currently employed?:

Yes No

Start Date

End Date

Location

Reason for Leaving and additional notes

Are you currently bounded by a non-competition, confidentiality, or Trade Secret Agreement?

Yes No

(If yes, please explain)

Explain here

Have you ever been discharged or asked to resign from job?

Yes No

(If yes, please explain)

Explain here

Have you ever been convicted or plead guilty to a felony crime other than a minor traffic violation?

Yes No

(If yes, please explain)

Explain here

Company

Address

Date Started

Date Left

Salary or Wage: Start

Hourly Weekly Yearly

Salary or Wage: End

Hourly Weekly Yearly

Company

Address

Date Started

Date Left

Salary or Wage: Start

Hourly Weekly Yearly

Salary or Wage: End

Hourly Weekly Yearly

(Please Specify)

Other (Please Specify)

Stand and/or walk for up to 6-8 hours

Yes No

Lift 40 pounds

Yes No

Twist upper torso 90 degrees

Yes No

Twist head/neck 90 degrees

Yes No

Do you have a valid driver's license?

Yes No

Have you been convicted for or pled guilty to any traffic-related offense within the past five years?

Yes No

Have you had your driver's license suspended or revoked, or had your driving privileges modified by a court of law?

Yes No

Please list all states from which you hold or have held a driver's license:

Careers

List below your most recent employers, beginning with most recent one

Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming

First Name *	Middle Name	Last Name *
Street Address * Apartment Number
City *		Zip Code *
Phone Number *
Email Address *

Name of high school attended *
City *
Name of teacher/counselor to contact as a reference * Department
Name of college attended
City

What position are you applying for? * Type of position you are seeking: Full - Time Part - Time
Total hours available per week * Date available to start work *

Please list the times you are available to work each day (e.g. "9:00am-3:30pm" or "after 3:30pm"):
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Are you 16 years old or older?: Yes No Are you 18 years old or older?: Yes No
Are you legally able to be employed in the U.S?: Yes No Are you on layoff and subject to recall?: Yes No Have you ever worked at Pizza Ranch before?: Yes No Still currently employed?: Yes No
Start Date End Date
Location Reason for Leaving and additional notes
Are you currently bounded by a non-competition, confidentiality, or Trade Secret Agreement? Yes No (If yes, please explain) Explain here
Have you ever been discharged or asked to resign from job? Yes No (If yes, please explain) Explain here
Have you ever been convicted or plead guilty to a felony crime other than a minor traffic violation? Yes No (If yes, please explain) Explain here

List below your most recent employers, beginning with most recent one
Company Address
Job Title	Supervisor	Phone Number
Still currently employed?:	Yes No
Date Started Date Left
Salary or Wage: Start Hourly Weekly Yearly Salary or Wage: End Hourly Weekly Yearly
Reason for Leaving

Company Address
Job Title	Supervisor	Phone Number
Still currently employed?:	Yes No
Date Started Date Left
Salary or Wage: Start Hourly Weekly Yearly Salary or Wage: End Hourly Weekly Yearly
Reason for Leaving

References (Do not list immediate family members)
Name Phone Number Years Known Relationship
Name Phone Number Years Known Relationship
Name Phone Number Years Known Relationship

How did you hear about the job opening? *
Website Visiting Existing Pizza Ranch® Newspaper Ad Referral
(Please Specify) Other (Please Specify)

The position you are applying for requires continuous walking, lifting, standing, bending, and other movement as well as verbal communication with co-workers and customers. Do you have the ability to perform the following essential functions of the job with or without reasonable accommodations?
Stand and/or walk for up to 6-8 hours Yes No
Lift 40 pounds Yes No
Twist upper torso 90 degrees Yes No
Twist head/neck 90 degrees Yes No

Minimum Age Requirement for a delivery driver position is 18. Must have a driver’s license valid under the laws of the state(s) where the team member works, acceptable motor vehicle record, proof of insurance, and satisfactory vehicle
Please answer the following questions if you are applying for a delivery driver position:
Do you have a valid driver's license? Yes No
(if yes) Driver's License Number Date of Issue
Have you been convicted for or pled guilty to any traffic-related offense within the past five years? Yes No
Have you had your driver's license suspended or revoked, or had your driving privileges modified by a court of law? Yes No
Please list all states from which you hold or have held a driver's license:
Thank you for your patience while your application is being successfully submitted.