Heavenly Pizza Tiffin – Driver Application Form

Driver/Brand Representative Application Form:

Heavenly Pizza, Tiffin, Ohio – An Equal Opportunity Employer
Personal Information:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Driver's License Number*
Submission of a Driver's License Number grants us permission to check your driving record.
Are You a U.S. Citizen?*

YesNo
Referred By:*
Position Applying For:

Driver/Brand Representative
Date You Can Start*

MonthDayYear
Education:
High School
Name of High School Attended
Number of Years Attended
Graduated?

Yes
College
Name of College/University Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Skills/Qualifications:
Special Skills
List any relevant skills
Special Strengths
List any relevant strengths or qualifications
U.S. Military Service
List any relevant experience
Long-Term Career Objective
List Career Objective
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Reason for Leaving?
Start Date

MonthDayYear
May We Contact?

YesNo
Previous Employment:
Previous Employer
Name of Previous Employer
Position
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Previous Employer
Name of Previous Employer
Position
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
References:
Reference 1
Name of Reference
Business/Profession
Phone
Years Known
Reference 2
Name of Reference
Business/Profession
Phone
Years Known
Reference 3
Name of Reference
Business/Profession
Phone
Years Known
Authorization:
"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE THE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM THE UTILIZATION OF SUCH INFORMATION.

I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED COMPANY REPRESENTATIVE.

THIS WAIVER DOES NOT PERMIT THE RELEASE OR USE OF DISABILITY-RELATED OR MEDICAL INFORMATION IN A MANNER PROHIBITED BY THE AMERICANS WITH DISABILITIES ACT (ADA) AND OTHER RELEVANT FEDERAL AND STATE LAWS."

IN CONJUNCTION WITH APPLYING FOR THIS POSTION AS A DELIVERY DRIVER, HEAVENLY PIZZA WILL REQUEST THEIR INSURANCE AGENT TO REVIEW YOUR MOTOR VEHICLE RECORD TO VERIFY, WHETHER YOU (APPLICANT) WOULD BE AN APPROVED DRIVER ON OUR INSURANCE. BY SIGNING THIS APPLICATION, YOU ARE GIVING HEAVENLY PIZZA AND THEIR AGENT PERMISSION TO ORDER SUCH REPORT. THAT REPORT WILL BE PROVIDED TO YOU UPON YOUR REQUEST.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Driver/Brand Representative Application Form:

Personal Information:

Position Applying For:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Authorization: