Application for Employment

Please provide complete information. An incomplete application may affect your consideration for employment.

Anthony's Pizza Holding Company, LLC and its affiliates, parent, and subsidiaries (collectively "APHC") is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin or ancestry, sex, sexual orientation, age, physical or mental disability, veteran status, genetic information or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances.

Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on APHC. Please inform the Company's Human Resources Department via e-mail at HR@acfp.com if you need assistance completing any forms or to otherwise participate in the application process.

General Information

Name *

First Middle Last

Address *

Street Address Address Line 2 City State ZIP Code

Contact Number *

Alternate Contact Number

Email (Optional) *

Date Available for Work *

Are you legally authorized to work in the United States? *

Yes

No

Do you now, or will you in the future, require immigration sponsorship for work authorization (e.g., H-1B)?

Yes

No

(If hired, verification will be required consistent with federal law.)

Are you under the age of 18?

Yes

No

If you are under the age of 18, please state your age.

(The primary reason for this question is to address any child labor laws.)

How were you referred to APHC?

Position Information

Type of work desired? *

Location Preferred

You may select more than one choice by holding down the CTRL key on a PC and the COMMAND key on a Mac and then clicking the various locations desired.

Wage range expected? *

Applying for: *

Full-Time

Part-Time

Seasonal

Employment Record

List all employment experience for the past 7 years, starting with the most recent or present employer. Using a separate section for each position, describe in detail all work experience including periods of unemployment. You may include as part of your employment history any verified work performed on a volunteer basis. Resumés may not be substituted in lieu of completing the following employment information.

NOTE: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Please select one of the following: *

This is my first job (skip this section)

This is not my first job (continue filling out this section)

Employer #1

Employer

Location

City State

Phone

Your Position

Supervisor's Name / Title

May we contact them?

Yes

No

Date started

Date ended

Reason for leaving

Employer #2

Employer

Location

City State

Phone

Your Position

Supervisor's Name / Title

May we contact them?

Yes

No

Date started

Date ended

Reason for leaving

Employer #3

Employer

Location

City State

Phone

Your Position

Supervisor's Name / Title

May we contact them?

Yes

No

Date started

Date ended

Reason for leaving

Education

High School or G.E.D. equivalent Name and Location

Highest grade completed?

College or University Name and Location

Did you graduate?

Yes

No

Background Information

During the past 7 years, have you ever been discharged, suspended or asked to resign from any position?

Yes

No

If yes, please explain.

For the purpose of verifying information on this application, have you ever worked or attended school under a different name at any of the organizations you have listed?

Yes

No

If yes, please specify name

Please note: A criminal background check may be required, if APHC later offers you employment. However, please also note that APHC does not have a policy that automatically disqualifies you from consideration from employment, if you have previously been convicted of a crime. Instead APHC will evaluate, on an individual basis, as to whether such a conviction should disqualify you from employment, reviewing a variety of factors, including the nature of the crime, the time elapsed, and the nature of the job.

Please Read Carefully and Initial Each Paragraph Before Submitting

I hereby certify that the information given by me is true in all respects. I authorize APHC and its representatives to contact my prior employers and all others for the purpose of verification of the information I have supplied and release same from any liability resulting from the information released. I authorize employers, school sand other persons named on this application to provide any information or transcripts requested. *

I understand employment with APHC is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States. *

I understand I may be subject to a pre-employment drug test after receiving a conditional offer of employment, and must receive a negative result for illegal drugs before being permitted to commence work with APHC. *

I expressly understand and agree that, if employed, my employment, having no specific term, is based upon mutual consent and may be terminated t will, with or without cause, by either party (APHC or me) without prior written notice to the other. *

As a condition of consideration for employment, I agree to waive my right to sue, and APHC hereby waives its right to sue me, for any and all claims or causes of action. IN lieu of suing, any such legal dispute may instead be submitted by me against APHC or APHC against memoir a final and binding resolution by a private, impartial arbitrator. The arbitration shall be governed by the Employment Arbitration Rules of the American Arbitration Association then in effect. A copy of these rules is available by asking APHC's Human Resources or can be found at www.adr.org. This agreement does not apply to or cover claims for which arbitration is unavailable, such as workers' compensation, unemployment compensation benefits, or charges under the National Labor Relations Act. *

I certify, under penalty of perjury, that all of the above information is true and complete, and I understand that any falsification or omission of information may result in denial of employment, if hired, may result in termination regardless of the time lapse before discovery. *

Note: An offer of employment is conditioned upon complying with APHC's requirements including, but not limited to signing a consent to conduct a background investigation and signing the Company's standard proprietary information agreement and arbitration agreement.

TYPING MY NAME REPRESENTS MY SIGNATURE AND IS EVIDENCE THAT I HAVE READ AND AGREE WITH ALL OF THE ABOVE STATEMENTS. *

Date

Phone

This field is for validation purposes and should be left unchanged.

Step 1 of 7

Application for Employment

General Information

Position Information

Employment Record

Employer #1

Employer #2

Employer #3

Education

Background Information

Voluntary Self Identification Form

Please Read Carefully and Initial Each Paragraph Before Submitting

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