Mama Lucia's Employment Application
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Social Security Number
You can also give us your SSN in private when you are hired if you don't want to put it online.
Are you over the age of 18?
*
Yes
No
Are you employed now?
*
Yes
No
Do you have reliable transportation?
*
Yes
No
Are you a citizen of the United States?
*
Yes
No - Explain
Have you ever worked for this company?
*
No
Yes - When?
Desired Position
*
Start Date
*
-
Month
-
Day
Year
When can you start working for us?
Education
Rows
School
Address
From
To
Graduated With
High-School
College
Other
Availability
*
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Day Shift
Night Shift
The interviewer will discuss shift times with you.
Do you understand that you will be required to work all holidays, even if they are out of your availability? (we are always closed on Thanksgiving Day and Christmas Day)
*
Yes
No - Explain
Is there anything in the near future that may change your availability? Mama Lucia’s requires a two week notice of availability changes, as long as we are able to accommodate your requests:
List any special skills or experience that would help you in the position you’re applying for:
Job / Reference 1
Reference Name
Start Month
-
Month
-
Day
Year
End Month
-
Month
-
Day
Year
Starting Salary
Ending Salary
Position
Supervisor
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Job Duties
Job 1 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reason for Leaving
May we contact this employer? If not, explain.
Job / Reference 2
Reference Name
Start Month
-
Month
-
Day
Year
End Month
-
Month
-
Day
Year
Starting Salary
Ending Salary
Position
Supervisor
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Job Duties
Job 2 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reason for Leaving
May we contact this employer? If not, explain.
Job / Reference 3
Reference Name
Start Month
-
Month
-
Day
Year
End Month
-
Month
-
Day
Year
Starting Salary
Ending Salary
Position
Supervisor
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Job Duties
Job 3 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reason for Leaving
May we contact this employer? If not, explain.
Save
Submit
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