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TELL US ABOUT YOURSELF
Jupiter’s Downtown or Jupiter’s At The Crossing
Personal Information
First Name: _
Present Address: _____________

Applying For: (check al that apply)
□ Barback
□ Dishwasher
□ Management
□ Pizza Cook
□ Service Support
□ Bartender
□ Line Cook
□ Prep Cook
□ Server
□ Utility/Maintenance
If hired, when are you available to begin? Have you ever applied to any of our restaurants before? Have you ever worked at any of our restaurants before? □ Online Ad
□ Newspaper Ad
□ Walk-in
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Education
High School
College/University
Employment History
Most Recent or Current Job
□ Resigned With Notice
□ Resigned With Notice
□ Resigned With Notice
□ Resigned Without Notice
□ Resigned Without Notice
□ Resigned Without Notice
□ Terminated
□ Terminated
□ Terminated
How many jobs have you held in the last 2 years?
Please explain the circumstances:
Work Schedule
Please list the hours you are available to work (hours may vary):
Availability
Wednesday
Thursday
Saturday
How many hours per week are you available to work? Are you wil ing to work holidays and weekends? Some of our earliest shifts begin at 8:00 a.m., and our last shift ends at 4:00 a.m. Do you have a reliable method of transportation to work during our hours of operation? Do you have any schedule obligations (i.e. annual trips, vacations, weddings, holidays, school, exams or other activities) coming up that your manager needs to know about? □ Yes □ No If yes, please note the dates that you wil need to be scheduled off:
Miscellaneous
Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodations?
If no, describe the functions that cannot be performed: Note: We comply with the Americans with Disabilities Act (ADA) and consider reasonable accommodations that may be necessary for eligible applicants/employees to perform essential functions of the
job.
Background
Have you ever been fired or asked to resign from a job?
If yes, from what employer, and for what reasons? Have you ever been disciplined or terminated for sexual harassment? Have you ever been convicted of a crime (excluding a marijuana related charge)? Certification and Agreement
I certify that the information given by me and in connection with this application is true and complete in al respects. I agree that if I am employed and such information is found to be false or incomplete in any way, at any time, I may then be subject to immediate dismissal without notice. I authorize the use of any information in this application to enable C.M.T. Ventures, Inc., to verify my statements. I authorize past employers, al references, and any other persons to answer al questions asked by C.M.T. Ventures, Inc., concerning my ability and employment record. I release such entities from any liability and damages arising out of its use and/or reliance on such information and documents requested. I also understand and agree that: 1. If employed, I am to work faithfully and diligently, to be careful and avoid accidents, and to comply with al present and subsequently issued C.M.T. Ventures, Inc., rules and policies. 2. This application is not an offer of employment, nor a contract of employment, and nothing contained in this application, any employee handbook, policy manual, or other C.M.T. Ventures, Inc., correspondence or document or in granting an interview is intended to create a contract between C.M.T. Ventures, Inc., and me for either employment or the provision of any benefits. 3. No promises regarding employment have been made to me and I understand that no such promises or guarantees are binding on C.M.T. Ventures, Inc., unless made in writing and signed by the owners. No manager, supervisor, or representative of C.M.T. Ventures, Inc., except its President, has the authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing. 4. If employed, I understand and agree that my employment is “at wil ” and for no definite period and that, regardless of the time and manner of payment of my wages or salary, my employment and compensation may be terminated at any time, at the option of either C.M.T. Ventures, Inc., or myself, with or without cause, and with or without previous notice. 5. I further understand that any offer of employment is conditioned on my being able to perform the essential functions of the position desired with any appropriate reasonable accommodation. 6. Upon termination of employment, C.M.T. Ventures, Inc. may answer al questions asked by a prospective employer concerning my ability and employment record, and I release C.M.T. Ventures, Inc., from liability or damages arising out of its response to any such questions. 7. I understand that C.M.T. Ventures, Inc. intends to maintain a drug free work place for the health and safety of its employees and others. To this end, I voluntarily consent and agree to participate in and cooperate with this program to the extent requested by C.M.T. Ventures, Inc. I further understand and agree that I may be required by C.M.T. Ventures, Inc., to undergo and successfully complete testing for alcohol and control ed substances as a condition for initial employment and, if employed, whenever requested by C.M.T. Ventures, Inc.,. 8. I authorize C.M.T. Ventures, Inc., to conduct or have a thorough investigation concerning myself and my background, including a criminal background investigation, and to have prepared a consumer investigative report, in connection with my application for employment. I agree to cooperate in any such investigation, and understand that any offer of employment by C.M.T. Ventures, Inc., or continued employment, if already employed, is contingent on the results of such investigation. I further understand that I have a continuing duty to immediately disclose to C.M.T. Ventures, Inc., any and al criminal charges and convictions as requested on this application that pertain to me from any prior liability or damages arising out of obtaining or out of its use and reliance on such 9. I authorize that al past employers, references, investigative agencies, bureaus, law enforcement agencies, schools, and any other person or government authorities to supply any information or specified or requested in this application concerning my background and myself. I release C.M.T. Ventures, Inc., from any liability or damages arising out of obtaining or out of its use of and reliance on such information. 10. I understand that I wil be notified in the event that C.M.T. Ventures, Inc. has requested and may use a consumer investigative report for employment purposes. I also understand that, upon my written request to C.M.T. Ventures, Inc.,, I wil be provided with the name and address of the consumer reporting firm and that I have the right to receive from the consumer reporting firm, a complete and accurate disclosure of the nature and scope of any consumer investigation report that has been prepared for C.M.T. Ventures, Inc. I also understand that if employment with C.M.T. Ventures, Inc. is denied based whol y or in part on information contained in the consumer investigative report, upon my written request to C.M.T. Ventures, Inc., I wil be provided with the name and address of the consumer reporting firm which, upon request, wil provide me with information regarding its report. I have read the above Certification and Agreement and fully understand it, and agree to its terms.
FOR COMPANY USE ONLY

Check Either A or B
A) The applicant did not receive a first interview due to: (please check one of the fol owing) □ Missing, illegible or incomplete information □ Schedule availability inconsistent with restaurant needs □ Previous job history/wage requirements inconsistent with restaurant needs □ Under Age employability inconsistent with restaurant needs □ Applicant’s expectations/standards inconsistent with restaurant needs B) The applicant received a first interview on: The reference check below was conducted on: Reviewer’s Name/Title:
Telephone Reference Check
Telephone Reference Introduction:
; I would like to verify some employment information on . May I verify some information regarding their work history? Company Name: _____________________________________ Company Name: _____________________________________ Company Name: _____________________________________ Phone: _____________________________________________ Phone: _____________________________________________ Phone: _____________________________________________ Person to Contact: ____________________________________ Person to Contact: ____________________________________ Person to Contact: ____________________________________ Dates of Employment: _______________ to _______________ Dates of Employment: _______________ to _______________ Dates of Employment: _______________ to _______________ Applicant’s Last Job Title: ______________________________ Applicant’s Last Job Title: ______________________________ Applicant’s Last Job Title: ______________________________ Applicant’s Last Rate of Pay: ____________________________ Applicant’s Last Rate of Pay: ____________________________ Applicant’s Last Rate of Pay: ____________________________ Reason for Leaving: ___________________________________ Reason for Leaving: ___________________________________ Reason for Leaving: ___________________________________ Eligible for Rehire: □ Yes □ No □ Unsure Eligible for Rehire: □ Yes □ No □ Unsure Eligible for Rehire: □ Yes □ No □ Unsure Overal , how would you rate this person to people you Overal , how would you rate this person to people you Overal , how would you rate this person to people you

Source: http://www.jupiterspizza.com/crossing/downloads/Jupiters_Application.pdf