Stazione Deli Job Application

Which Location(s) are you applying for? *
Separate each with a comma
Date*

MonthDayYear
Date
PERSONAL INFORMATION
Name*

First NameLast Name
Social Security Number*
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived there? Years* Months
Previous Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long did you live there? Years * Months *
Phone Number*
Please enter a valid phone number.
If hired, can you offer proof that you are at least 18 years of age? *
Yes / No
Can you show proof of your eligibility to work in the U.S?*
Yes / No
In case of emergency, please notify:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Have you ever been convicted of a crime? *
If "yes" you may be asked to supply a summary of details. A conviction will be considered only as it relates to fitness to perform the job being sought.
If you have been CONVICTED of a crime, please explain here.
ID Number Number Type of ID ID, License, Other
State Expiration Date MM/YYYY
A copy of your driving record may be obtained from the Office of Motor Vehicles.

EMPLOYMENT DESIRED
Position applying for:*
Date you can start:*

MonthDayYear
Date
Salary Desired: Dollar Amount* Per Hour / Year*
Are you employed now?*
Type Yes or No
If Yes, may we inquire of your present employer? *
Type Yes or No
Ever applied to Stazione Deli before? *
How were you referred? *
Facebook, Employee, Newspaper, Other

Education
High School*

School Name

School Address

MajorYears Attended

Diploma
College*

School Name

School Address

MajorYears Attended

Diploma
Business, Technical, or Special Training.

Employment History

Please give a complete record of all previous work experience, starting with your present or last job.
1.

Employer Name

Employer Address

Phone NumberPosition

Supervisor Name
I was employed from MM/YYYY to MM/YYYY
Salary:
Reason for Leaving:
2.

Employer Name

Employer Address

Phone NumberPosition

Supervisor Name
I was employed from MM/YYYY to MM/YYYY
Salary:
Reason for Leaving:
3.

Employer Name

Employer Address

Phone NumberPosition

Supervisor Name
I was employed from MM/YYYY to MM/YYYY
Salary:
Reason for Leaving:
4.

Employer Name

Employer Address

Phone NumberPosition

Supervisor Name
I was employed from MM/YYYY to MM/YYYY
Salary:
Reason for Leaving:
QUALIFICATIONS
Please list all job skills that relate to the position for which you are applying, such as mechanical skills or office skills. Include any machines which you can operate, typing speed, computer experience, or any other skills which qualify you for this position.

Please review the Job Description for the position for which you are applying. Are you able to perform the essential functions of this job with or without reasonable accommodations? *
Type Yes or No
TERMS OF EMPLOYMENT
I certify that all information given on this Employment Application, any resume that I submit to the Company, and any related employment papers and answers given during oral interviews are true and correct. I authorize the Company to verify such information and to contact any reference given by me. Should I be employed by the Company, I agree that my employment shall be in accordance with the terms of this application and I agree to abide by the Company rules and regulations and any amendments thereto.
I acknowledge and agree that my employment is for no definite period of time and that no documents of the Company shall constitute a contract of employment. I understand that my employment may be terminated or I may resign at any time, with or without cause, and with or without notice. The policy set forth in this paragraph may be modified only by written agreement signed by me and by an officer of the Company.
The Company shall have the right at any time after the termination of my employment to furnish to others information concerning my employment record, work habits, and work performance with the Company, its officers, directors, agents, and employees from any and all liability regarding the release of any information described in this paragraph. I authorize the Company to investigate all statements contained in this application and hereby release former employers and the Company from any and all liability on account of furnishing such information to the Company.
I agree that employment is contingent upon meeting all placement considerations, including, but not limited to, submitting to and successfully completing a post-offer company medical examination, and/or drug and alcohol testing.
FALSIFICATION, MISREPRESENTATION, OR OMISSION OF INFORMATION ON THIS, OR ON
ANY OTHER EMPLOYMENT FORM MAY RESULT IN A DENIAL OF ANY RIGHT I OR MY
DEPENDENTS MAY HAVE TO WORKER’S COMPENSATION BENEFITS, INCLUDING MEDICAL
TREATMENT AND EXPENSES, AND SHALL BE GROUNDS FOR IMMEDIATE TERMINATION,
REGARDLESS OF WHEN SUCH FALSIFICATION, MISREPRESENTATION, OR OMISSION IS
DISCOVERED.
By typing "I Accept" , you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By typing "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Application. You further agree that your signature on this document is as valid as if you signed the document in writing. *
Type "I Accept" or "I Decline"
Date*

MonthDayYear
Date
Applicants Signature:*
LAKESIDE SERVICE is an qual opportunity employer.
Should be Empty: