Employment Must be at least 17 years of age to apply *REQUIRED PERSONNAL INFORMATION Your Name*(Last, First, Middle): Date of Birth*: Gender: MALE FEMALE Ethnicity: Marital Status: Email*: Home Phone* : Cell Phone: Street Address*: City, State, Zip*: How long have you lived at your current address? How long have you lived in the New Orleans area? Are you a U.S. Citizen: YES NO What position are you applying for? Can you work*: Anytime Days Evenings Weekdays Weekends Are there days you cannot work? Do you own an automobile?* YES NO Have you ever been convicted of a felony or misdemeanor, a violent crime, or a retail related crime (i.e. shoplifting, credit card fraud, theft, burglary)*? YES NO If YES, please explain the nature of the crime(s) and the dates of convection(s): You do not need to disclose any information regarding arrest, criminal charges and convictions that have been expunged, annulled, sealed, erased, dismissed or overturned from your record. NOTE: a conviction will not disqualify you from employment. WORK HISTORY Current or Most Recent Employer*: Address* (include city, state): Phone number*: Name of Immediate Supervisor*: Dates of employment*: Position/Job Title: What was your pay rate at your last job?* Reason for leaving*: br> May we contact this employer?*: YES NO EDUCATION HISTORY High School: br> College: br> Trade School: br> Other: br> List any applicable special skill, training or proficiencies: br> REFERENCES Please list 3 references: Reference 1___________ Name*: Relationship*: Phone Number*: Address*: Occupation*: Reference 2____________ Name*: Relationship*: Phone Number*: Address*: Occupation*: Reference 3___________ Name*: Relationship*: Phone Number*: Address*: Occupation*: Why do you think you would be a good fit for Zuppardo's? By clicking SEND, I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired. I also provide consent for former employers to be contacted regarding work records.