Application Form For Crew Member Employment (Page 2 of 2) in pdf

Availability for Work

What hours or shifts are you available for work? Please note both hours available and hours unavailable to work in the table below.

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Availability

Available

Not Available

10.

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

Yes

If yes, please explain. _____________________________________________________________________________

________________________________________________________________________________________________

11.

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

Other Notes or Comments:

Experience

Job 1

Job 2

Job 3

Employer

Address/Location

(Include City, State, & ZIP)

Dates Employed

From_______ to _______

Mo/Yr

Position(s) Held

Supervisor's Name

Phone Number

Starting Salary/Wages

$_____________________

Final Salary/Wages

$_____________________

May we contact this employer?

Yes

Responsibilities

Reason for Leaving

I represent that the above information, and other information I may be required to provide, is complete and accurate and any misstatement or ommision may result

in rejection of my application or termination of employment. I authorize LCE to conduct, at its discretion, felony conviction and motor vehicle record searches. I

authorizemy 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 that "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 personaly

gain or for the benefit of a third party.

Signature

Date

This application was designed to comply with Federal Civil Rights Act, Title VII, the Age discrimination Act of 1967, The Americans with Disabilities Act, The Civil

Rights Act of 1991 and State Fair Employment Practice Laws. Therefore, no question answered is or will be used to discriminate adversely in matters of race, color,

marital status, national origin, religion, age, sex, disability, Veteran status, or any other characteristics protected by state or local laws.

Applications are effective for 60 days, after which you must reapply.