LPC Job Application Question Title * 1. Which LPC location are you applying to? Question Title * 2. Please enter your contact info: Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 3. Social Security Number: Question Title * 4. Are you entitiled to work in the United States? Yes No Question Title * 5. Have you been convicted of a felony or been incarcerated in connection with a crime in the past 7 years? Yes No Question Title * 6. If you answered "Yes" above, please explain. Question Title * 7. Highest level of education? Question Title * 8. List any special certifications or licenses that you have that apply to this job. (Serve-safe, etc.) Question Title * 9. How were you referred to Lost Pizza Co. Question Title * 10. What position/location you are applying for? Kitchen Front of house Either Question Title * 11. Military Service? Yes No Question Title * 12. Which Branch? Question Title * 13. Availability-Are you currently employed? Yes No Question Title * 14. If so, where and when? Question Title * 15. Are you currently in school? Yes No Question Title * 16. If so, When are your classes? Question Title * 17. Expected hourly rate? Question Title * 18. What days/shifts are you available to work at Lost Pizza Co? Monday Lunch Monday Dinner Tuesday Lunch Tuesday Dinner Wednesday Lunch Wednesday Dinner Thursday Lunch Thursday Dinner Friday Lunch Friday Dinner Saturday Lunch Saturday Dinner Sunday Lunch Sunday Dinner Question Title * 19. Date available to start? Date / Time Date Question Title * 20. Prior Work Experience-List Employer's info: Name Company Address City/Town State/Province ZIP/Postal Code Question Title * 21. Job Title: Question Title * 22. Responsibilities: Question Title * 23. How long did you work here? Question Title * 24. Reason for leaving? Question Title * 25. Reason for leaving? Question Title * 26. Supervisor's contact info: Name Email Address Phone Number Question Title * 27. May we contact this employer? Yes No Question Title * 28. Prior Work Experience-List Employer's info: Name Company Address City/Town State/Province ZIP/Postal Code Question Title * 29. Job Title: Question Title * 30. Responsibilities: Question Title * 31. How long did you work here? Question Title * 32. Reason for leaving? Question Title * 33. Supervisor's contact info: Name Email Address Phone Number Question Title * 34. May we contact this employer? Yes No Question Title * 35. More prior work experience-Email resumes and other info to Jobs@lostpizza.comPlease list any other jobs that relate to this one: Question Title * 36. E-Signature-Disclaimer- By typing my name here, I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or may lead to my dismissal if hired. I also provide consent for employers to be contacted regarding my work records. E-Signature Date Done