Name *

First Name

Last Name

Phone *

(###)

###

####

May we text you?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Can you provide documentation that verifies you are legally eligible to work in the United States? *

Yes

No

Are you 18 years of age or older? *

Yes

No

Are you able to meet the capability requirements outlined in the job description with reasonable accommodations? *

Yes

No

Have you ever been employed with HOTLIPS Pizza? *

Yes

No

Check the following boxes to indicate your availability

Monday Midday

Monday Close

Tuesday Midday

Tuesday Close

Wednesday Middday

Wednesday Close

Thursday Midday

Thursday Close

Friday Midday

Friday Close

Saturday Midday

Saturday Close

Sunday Midday

Sunday Close

When are you available to start? *

MM

DD

YYYY

Gender

Male

Female

Non-Binary

I do not wish to disclose

If you choose to voluntarily self-identify, please mark the one box describing the race/ethnicity with which you identify:

American Indian or Alaska Native (I) (Non-Hispanic or Latino): A person having origins in any of the original peoples of North and South American (including central America), and who maintain a tribal affiliation or community attachment.

Asian (A) (Non-Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

Black or African American (B) (Non-Hispanic or Latino): A person having origins in any of the black racial groups of Africa. Hispanic or Latino (H): A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin regardless of race.

Native Hawaiian or Other Pacific Islander (P) (Non-Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White (W) (Non-Hispanic or Latino): All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Two or more races (T) (Non-Hispanic or Latino): Persons who identify with two or more racial categories name above.

I do not wish to disclose

Under this definition, are you a person with a disability?

Yes

No

I do not wish to disclose

Have you served in the United States Military Armed Forces?

Yes

No

I do not wish to disclose