Application for Employment-Pittsburgh
(*) Required:
How did you hear about us? (*)
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Location: (*)
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Last Name: (*)
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First Name: (*)
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Middle Intial:
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Address: (*)
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City: (*)
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State: (*)
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Zip: (*)
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Phone Number: (*)
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Alternate Phone:
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E-Mail: (*)
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Emergency Contact:
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Phone Number:
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(*) Required:
Position(s) Applying For:
(*)










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Other position(s)
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Type of Work Looking For:
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Days Available:
(*)
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Nights Available:
(*)
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Specific Hours:
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(*) Required:
On what date would you be available to work? (*)
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Do you have consistent transportation to and from work?
Explain:
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Are you authorized to work in the U.S.?
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If NO, do you have authorization to work?
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Have you ever been convicted of a felony?
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If YES, please explain what, where and the charge:
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Have you been employed during the last six months?
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Explain:
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Are you at least 18 years of age?
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How many years of food service experience do you have?
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(*) Required:
EDUCATION AND CERTIFICATIONS
High School:
Name and City of School
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Years Completed
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Last Year Completed:
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Date Graduated:
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High School #2:
Name and City of School
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Last Year Completed:
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Date Graduated:
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College:
Name and City of School
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Years Completed
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Last Year Completed:
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Date Graduated:
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College #2:
Name and City of School
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Last Year Completed:
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Date Graduated:
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Other:
Name and City of School
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Last Year Completed:
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Date Graduated:
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Other:
Name and City of School
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Last Year Completed:
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Date Graduated:
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Military Service:
From:
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To:
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Branch:
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Rank and Duties:
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PREVIOUS EXPERIENCE (Begin With Most Recent Employer)
Please provide at least two employers
Employer: (*)
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City and State:
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Phone:
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Position:
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Duties:
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Supervisor's Name:
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Wages/Salary:
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From:
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To:
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Reason for Leaving:
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Employer #2:
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City and State:
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Phone:
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Position:
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Duties:
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Supervisor's Name:
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Wages/Salary:
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From:
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To:
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Reason for Leaving:
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Employer #3:
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City and State:
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Phone:
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Position:
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Duties:
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Supervisor's Name:
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Wages/Salary:
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From:
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To:
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Reason for Leaving:
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Employer #4:
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City and State:
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Phone:
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Position:
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Duties:
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Supervisor's Name:
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Wages/Salary:
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From:
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To:
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Reason for Leaving:
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PROVIDE TWO PROFESSIONAL AND PERSONAL REFERENCES
Professional:
Name:
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Company:
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Years Known:
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Phone:
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Name:
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Company:
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Years Known:
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Phone:
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Personal:
Name:
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Years Known:
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Phone:
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Name:
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Years Known:
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Phone:
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Optional
Attach a resumé
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Attach a cover letter
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I certify that the above information is true and complete. I understand that any false statement I have made herein or my failure to disclose requested information may disqualify me for consideration for employment, or if employed, may result in my termination. I further authorize LGC Associates, LLC or its agent to perform an investigation of local, state and federal records relating to any criminal convictions I may have. In addition, LGC Associates, LLC has my permission to obtain all necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history, or criminal history and I release all parties from any possible damages resulting from disclosing such information with or without prior written notice to me. I understand and acknowledge that I may be required to undergo a post-offer pre-employment physical exam and a post-offer pre-employment drug screening analysis for substance abuse. I understand that these may, to the extent permitted by law, result in the revocation of any offer of employment. I certify that this application does not constitute and employment contract of any kind. I further acknowledge that, if I am offered a position with LGC Associates, LLC, my employment may be terminated at any time, with or without notice or cause, except as otherwise provided by law.
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