Name: *

First Name

Last Name

Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone: *

(###)

###

####

Home Phone:

(###)

###

####

Emergency Contact Number: *

(###)

###

####

Are you at least 18 years old? *

Yes

No

Are you legally able to work in the U.S.? *

Yes

No

Have you worked at Ciro's before? *

Yes

No

Being on your feet 6-9 hours at a time is a requirement for all positions. Are you able and willing to comply with this requirement? *

Yes

No

Are you willing to work holidays, weekends and flexible hours? *

Yes

No

Availability: *

If available, check box.

Monday 9AM - 4PM

Monday 4PM - 10PM

Tuesday 9AM - 4PM

Tuesday 4PM - 10PM

Wednesday 9AM - 4PM

Wednesday 4PM - 10PM

Thursday 9AM - 4PM

Thursday 4PM - 10PM

Friday 9AM - 4PM

Friday 4PM - 11PM

Saturday 9AM - 4PM

Saturday 4PM - 11PM

Sunday 9AM - 4PM

Sunday 4PM - 10PM

Position applying for: *

In-House (Cashier, Kitchen Crew, Busser) (Must be minimum 16 years of age)

Pizza Delivery Driver (Must be minimum 18 years of age with reliable vehicle)

Both Driver and In-House

Last Grade Completed: *

9th Grade

10th Grade

11th Grade

12th Grade

College

Employer Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone Number:

(###)

###

####

Personal Reference:

First Name

Last Name

Phone Number:

(###)

###

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Legal (read below): *

The Secretary of Health and Human Services has determined that certain diseases, including hepatitis A, salmonella, Shigella, staphylococcus, streptococcus, Giardia, E, Coli and Campylobacter may prevent you from serving food or handling food equipment in a sanitary and healthy fashion. Is there any reason why you cannot perform the essential functions of this job?

Yes

No

In the past 7 years, have you ever been convicted of or plead guilty to a crime, excluding misdemeanors and traffic violations? *

Yes

No

Have you been active in the U.S. Armed Forces in the past? *

Yes

No

Applicant's Affirmation and Agreement: I hereby affirm that the information on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. If I am employed by Ciro’s Pizza Cafe (Boardwalk Restaurant Group Inc), this document will become part of my permanent record. I also agree and understand that any misrepresentation or omission of any material information on this application or in the interviewing process or on my resume, may preclude me from an offer of employment, or may result in a withdrawal of an employment offer, or may result in my discharge from employment if I am already employed at the time the misrepresentation or omission is discovered.  I agree that if employed, I will abide by all policies and procedures established by Ciros Pizza Cafe. I understand that my employment is "at will ," and that Ciros Pizza may terminate my employment at any time, with or without cause and with or without notice. I understand that no manager or representative of Ciros Pizza, other than its President and CEO or his designee, has any authority to enter into any agreement for employment for any specified period of time or make any agreement contrary to the foregoing either now, in the past or in the future. I further understand that such an agreement must be in writing and signed by the President, CEO, and me for it to be binding on either Ciros Pizza or myself. I further understand that this statement supersedes any prior oral or written understanding and bars any future oral understanding to the contrary.  I also recognize that the use of drugs and alcohol can create an unsafe working environment, and that Ciros Pizza Cafe is a drug-free, smoke-free workplace. *

I agree to the terms

I do not agree to the terms

Date *

MM

DD

YYYY