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Applicant Information

* Please include your FULL NAME as displayed on your government issued ID.

Name:*

Please list any other names you have used.

Phone Number:*

Email:*

Address:*

City:*

State:*

Zip Code*

Position Desired:*

Day Phone Number

Evening Phone Number

Social Security Number

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Address

How soon after accepting an offer would you be able to start working?*

Do you have any obligations which would affect working as scheduled?*

If yes, please explain

Availability

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Personal

1. Are you at least 18 years old?*

If no, please list birth date.

2. Do you have the legal right to remain and work in the United States?*

Notes

3. Have you ever been employed by Little Caesars before?*

If yes, when, where, who was your immediate supervisor/owner and why did you leave?

4. What prompted you to apply to work here? Other:

5. Have you ever been convicted of a felony?*

If yes, please explain all convictions.

6. What are your personal interests or hobbies?*

7. Job-related organizations, clubs professional societies (Omit those which indicate sex, race, religion, creed, color, national origin, ancestry, and/or age)

8. Is any members of your family (spouse, parent, etc) employed in the restaurant industry? *

If yes, explain

Education: High School

Name and Location

Dates Attended (from / to)

Years Completed

Major and Minor Fields of Study

Degree/Diploma

Honors Received

Education: Technical / Vocational

Name and Location

Dates Attended (from / to)

Years Completed

Major and Minor Fields of Study

Degree / Diploma

Honors Received

Education: College / University

Name and Location

Dates Attended (from / to)

Years Completed

Major and Minor Fields of Study

Degree / Diploma

Honors Received

Education: Other

Name and Location

Dates Attended (from / to)

Years Completed

Major and Minor Fields of Study

Degree / Diploma

Honors Received

Experience

1. Employer

1. Address/Location (include City, State & Zip)

1. Dates Employed (from / to)

1. Position(s) Held

1. Supervisors Name

1. Phone Number

1. Starting Salary/Wages

1. Final Salary/Wages

1. May we contact this employer?

1. Responsibilities

1. Reason for Leaving

Notes

2. Employer

2. Address/Location (include City, State & Zip)

2. Dates Employed (from / to)

2. Position(s) Held

2. Supervisor Name

2. Phone Number

2. Starting Salary/Wages

2. Final Salary/Wages

2. May we contact this employer?

2. Responsibilities

2. Reason for Leaving

Notes

3. Employer

3. Address/Location (include City, State & Zip)

3. Dates Employed (from / to)

3. Position(s) Held

3. Supervisor Name

3. Phone Number

3. Starting Salary/Wages

3. Final Salary/Wages

3. May we contact his employer?

3. Responsibilities

3. Reason for Leaving

Notes

Agreement

I represent that the above information, and other information I may be required to provide, is accurate and any misstatement or omission may result in rejection of my application or termination of employment. I authorize LCE to conduct, at its discretion, felony convictions and motor vehicle record search. I authorize my references and any state or local agency to release any information they may have regarding me to Little Caesars Enterprises, Inc. (LCE) and I release all parties from any liability for requesting and/or providing such information.

I agree that if I am hired, my employment may be terminated at any time for any reason at all with or without notice by me or LCE. I agree that only the President of LCE has authority to enter into an employment arrangement other than "at will" and it must be in writing and signed by the President and me.

I agree to keep confidential all proprietary information I learn about LCE by virtue of my employment with LCE and shall not disclose it or use it for my own personal gain or for the benefit of a third party.

Signature*

Today's Date*

Application

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