Do you have a dependable way to get to work?
Select Yes No
Please explain


Our hours vary from week to week and occasionally you may be asked to stay late, leave early, or come in on your day off.  What problems do your foresee with this?


Are you aware of any reason that you cannot perform essential functions of the job with or without reasonable accommodations?
Select Yes No
If so, specify


What prompted you to apply to Little Caesars? 
Select Walk In Newspaper Ad Outside Building Sign Inside Sign Referral Other

If a referral, please specify: 
If other, please specify: 

Education
Are you a high school co-op/work study student? 
Select Yes No
Are you currently attending school?
Select Yes No

Work History
Company

From (Month & Year)

To (Month & Year)

Street Address

City/State

Position

Salary

Supervisor

List of duties

Reason for leaving


Company

From (Month & Year)

To (Month & Year)

Street Address

City/State

Position

Salary

Supervisor

List of duties

Reason for leaving


Referrals


Documentation
To comply with the Federal Employment Eligibility Verification Law you must bring either one document from List A OR on document from List B and one document from List C as follows:

List A
-United States Passport
-Certificate of United States Citizenship
-Certificate of Naturalization
-Unexpired Foreign Passport with Employment Authorization
-Alien Registration Card with Photograph

List B
-Unexpired State-Issued Drivers License
-Unexpired State-Issued Identification Card
-School Identification Card with Photograph
-Voters Registration Card
-United States Military Card

For persons under age 18 who are unable to present a document listed above:
-School Record or Report Card
-Clinic, Doctor, or Hospital Record
-Daycare or Nursery School Record

List C
-Social Security Card (original)
-An Original or Certified Copy of a Birth Certificate Issued by a State or County, Bearing an Official Seal

Failure to provide the document(s) required by law will result in immediate termination.

Fair Credit Reporting Act and Employment At Will Disclosure
I understand I am applying for employment which can be terminated at will by either myself or Little Caesars at any time and that nothing contained in any manual, brochure, or other Little Caesars materials shall constitute an implied contract for employment or continued employment.  I also acknowledge that Hardee's may request previous employment information to evaluate my qualifications for employment.  Upon written request, information as to the nature and scope of such report will be provided.  I understand that false or incomplete information in this application for employment is grounds for dismissal and forfeiture of all related benefits.  Applications may be kept in files for 60 days if not hired.

I certify that the information on this application is accurate and complete.

Signature (type full name)

Date

I understand that typing my full name in the box above is considered an official signature.

To submit this form, please enter the characters you see in the image: