Please circle the Grotto location:

Delaware:

Any S. Bethany W. Bethany DT. Bethany Dewey

N. Boardwalk S. Boardwalk Rehoboth Ave Grand Slam

Long Neck Seaford Milford Dover Camden-Wyoming Employment Application Middletown Newark Concord Pike Ave Location # :

Ocean City -125th Ocean City-Boardwalk

Gambrills Columbia

Name______SS# ______

Primary Address______

City______State______Zip______Phone # ( )______

Secondary Address______

City______State______Zip______Phone # ( )______

Are You ( check one) _____15 ______16-17 ______18 ______19 ______20 ______21 or older

Have you ever been convicted of a felony? ______no _____yes*

If yes, explain ______*Being convicted of a felony does not automatically preclude employment. Seasonal Employment: Year-round Employment Full time______Part time____ Full Time—Management ______

Dates Available Variable / No restrictions ______

From_____ To______Part Time / Some restrictions ______

Position Desired:

____ Pizza Maker _____ Bartender ____Delivery Driver (age 18)

_____Bus Person _____Kitchen ____Delivery Telephones

_____Server _____Dishwasher _____Host / Hostess

Education:

High School______Did you Graduate? ______Course of Study______

College ______Did you Graduate? ______Course of Study______

Special Training or Skills: List special training or skills acquired through education and / or work–related experience:

______.

Have you ever applied or worked for Grotto Pizza in the past? ______No ______Yes

How did you learn about us? (Circle One) Ad Job Fair Relative/Friend Walk in Social Media Website

Do you know anyone who works for Grotto Pizza? ______No ______Yes

If yes, name:______

References:

Please list two references (other than relatives or friends):

Name Address Phone # Years Known

______

______

Work History ( List in order of date)

Dates of Employment Company and Address Phone # Position Duties Salary Supervisor Reason For Leaving

From To

From To

From To

I certify that the facts contained in the application are complete to the best of my knowledge and understand that , if employed, falsified statements on this application shall be grounds for my dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that might result from furnishing same to you. I understand that if hired, employment with Grotto Pizza Inc. is at will. Grotto Pizza Inc. retains the right to termi- nate employment at any time, for any reason, with or without notice. I understand also that I am required to abide by all rules and regulations of Grotto Pizza Inc.

Signature: ______Date: ______

Grotto Pizza, Inc. is an equal opportunity employer M/F/V/D