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APPLICATION FOR CREW MEMBER EMPLOYMENT

Last Name First Name Middle Date of Application

Street/P.O. Box Apt. # City State ZIP

Day Phone No. Evening Phone No. Social Security No.

Please list and other names you have used. Crew Member Full-Time

Delivery Driver Part-Time

Emergency Contact's Name Home Phone No. Work Phone No.

Street/P.O. Box Apt. # City State ZIP

Personal 1. Are you at least 18 years old?

If no, please list birth date. __________________ Yes No

2. Do you have the legal right to remain and work in the United States? Yes No

(Authorization for employment and Proof of Identity required upon employment)

3. Have you ever been employed by Little Caesars before? Yes No

If so, when? ___________________ City_________________________ State________

Who was your immediate supervisor/owner?_____________________________________

Why did you leave?_________________________________________________________

4. What prompted you to apply for work here? Company Image Agency

Friend Employee Referal Newspaper Other__________________

5. Have you ever been convicted of a felony? Yes No

If yes, please explain all convictions._______________________________________________________________________

____________________________________________________________________________________________________

6. What are your personal interests or hobbies?________________________________________________________________

____________________________________________________________________________________________________

7. Job-related organizations, clubs, professional societies. (Omit those which indicate sex, race, religion, creed, color,

national origin, ancestry, and/or age.)______________________________________________________________________

8. Is any member of your family (spouse, parent, etc.) employed in the restaurant industry? Yes No

If yes, explain. ________________________________________________________________________________________

Education

High School

Technical/

Vocational

College/

University

Other

Honors Received

Degree(s) or Diploma

1 2 3 4

Year Completed Circle Highest

9 10 11 12

Fileds of Study Major and MinorName and Location

of School (From/To) Dates Attended

Availability for Work 9. What hours or shifts are you available for work? Please note both hours available and hours unavailable to work in the table below.

Availability Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Available

Not Available

10. Do you have any obligations which would...