Welcome to Mary's Pizza Shack!

* Required Fields

*Applying for:
Shack Crew Member Shack Management Home Office

*Please select location preference:

Anderson	Boyes Hot Springs	Cloverdale
Dixon	East Santa Rosa	Fairfield
Napa	Novato	Petaluma
Rohnert Park	Roseville	Santa Rosa Downtown
Sebastopol	Sonoma Plaza	Vacaville
Walnut Creek	West Santa Rosa	Windsor

PERSONAL INFORMATION:

*First Name:

Middle:

*Last:

Present Address:

*Street:

*City:

*State:

*Zip:

Permanent Address:
Leave this blank if same as above

Street:

City:

State:

Zip:

*Phone # where you can be reached:	*Are you 18 years or older?: YES: NO:
*Email address:

EMPLOYMENT DESIRED:

Position:

Date you can start:

Salary desired:

If not sure, leave blank

Have you ever applied to this company before?

YES: NO:

Where?

When?

*Are you employed now: YES: NO:

If so, may we request information from your present employer?

YES: NO:

*How did you learn about us?

EDUCATION:

EDUCATION:	Name & location of school:	Years attended?	Did you graduate?	Subjects Studied?
Grammar School:			Yes: No:
High School:			Yes: No:
College:			Yes: No:
Trade, Busines or Correspondence School			Yes: No:

PREVIOUS EMPLOYERS:

*Employer:	*Duration of employment:	*Position:
*Reason for leaving:

Employer:	Duration of employment:	Position:
Reason for leaving:

REFERENCES: Give the names of three (3) persons not related to you, whom you have known at least one year.

(1) *Name:

*Address:

*Occupation:

*Years Acquainted:

(2) *Name:

*Address:

*Occupation:

*Years Acquainted:

(3) *Name:

*Address:

*Occupation:

*Years Acquainted:

PHYSICAL RECORD:

Do you have any physical limitations that preclude you from performing any work for which you are being considered?

YES: NO:

If "YES", what can be done to accommodate your limitations?

LAST QUESTION: Why should Mary's Pizza Shack hire you?