Please circle the Grotto Pizza 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 Pennsylvania Ave Location # Maryland: 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 .