Applicant Name:

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Zip Code:

Date of Birth:

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Employment Positions

Position(s) applying for:

Are you applying for:
Temporary Work - such as summer or holidays only?Regular part-time work?Regular full-time work?Weekends only?

What days and hours are you available to work?

If hired, on what date can you start working?

Will you work on the weekends?
YesNo

Are you available to work overtime?
YesNo

Salary desired ($ per hour):

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Personal Information

Have you ever applied to or worked for Borromeo's before?
YesNo

If yes, when (include dates) & reason for leaving

Are you over the age of 18yrs?
YesNo
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?
YesNo
Have you ever been convicted of a Felony?
YesNo
If yes, when (include dates) & nature of crime

Are you willing to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
YesNo
If no, describe the functions that you cannot perform

Positions previously held, phone number, and contact reference:
1

2

3

4

5

Why do you want to be employed at Borromeo's Pizza and Italian Restaurant?

By clicking submit, I understand that the information I have provided on this employment application form will be transmitted electronically to a web server and stored for retrieval and review. Borromeo's Pizza and Italian (www.borromeos.com) does not share applicant information. Once the position(s) is/are filled, all stored data will be deleted from the web server.

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