Employment Application

Employment Application

Name

Street Address

First

Middle

Last

Apt. No.

or Box

City

State

Zip

Phone

Are you 18

Ever worked in a Papa Murphy’s before?

or Older?

If not, age?

If yes, Dates & Location

AVAILABILITY

M

T

W

T

F

S

S

Total Hours

Hours

From

Available Per Week

Available:

To

How Far do

Do You Have

Are You Legally Able to

How did You

You Live From

Transportation

Be Employed in the U.S.? Yes

No

Hear of Job?____________________ Restaurant? _______

To Work? _______

SCHOOL MOST RECENTLY ATTENDED

Name__________________________________ Location_______________________________ Phone __________________

Teacher or

Last Grade

Graduated?

Yes

No

Counselor ______________________________ Completed ____________________________ Now Enrolled?

Yes

No

Sports or Activities ______________________________________________________________________________________

Beginning with most recent:

EMPLOYMENT HISTORY(If not applicable, list U.S. Military, work performed on a voluntary basis or personal references)

Company________________________________ Address _______________________________________________________

Phone __________________________________ Job ___________________________________________________________

Supervisor ______________________________ Dates Worked: From __________ To __________

Salary __________________________________ Reason for Leaving ______________________________________________

EMPLOYMENT HISTORY(If not applicable, list U.S. Military, work performed on a voluntary basis or personal references)

Company________________________________ Address _______________________________________________________

Phone __________________________________ Job ___________________________________________________________

Supervisor ______________________________ Dates Worked: From __________ To __________

Salary __________________________________ Reason for Leaving ______________________________________________

EMPLOYMENT HISTORY(If not applicable, list U.S. Military, work performed on a voluntary basis or personal references)

Company________________________________ Address _______________________________________________________

Phone __________________________________ Job ___________________________________________________________

Supervisor ______________________________ Dates Worked: From __________ To __________

Salary __________________________________ Reason for Leaving ______________________________________________

Are you capable of performing the essential functions of the job for which you have applied, with/without a reasonable

accommodation? _____ Yes _____ No

___ Yes ___ No

HAVE YOU EVER BEEN CONVICTED OF VIOLATING ANY LAW (EXCEPT MINOR TRAFFIC VIOLATIONS)?

If yes, please attach a summary of details. Disclosure of a criminal record does not automatically disqualify you from employment

consideration. Your case will be judged on its own merits.

Person to contact in case of an emergency:

Name

_________________________________ Address ________________________________________________________

Phone

(HM)_____________________ (WK)______________________

1. I certify that the information contained in the application is correct to the best of my knowledge and understand that any omission or erroneous information is grounds for dismissal. 2. I

authorize the references listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all

parties from all liability for any damage that may result from furnishing same to you. 3. I acknowledge that, if I become employed, I will be free to terminate my employment at any time for

any reason and Papa Murphy’s retains the same rights. No Papa Murphy’s representative has the authority to make any contrary agreement. This application does not establish an

employment contract.

Signature:

Date

Revised 1/00

____________________________________________________________________________________________

__________________________