Application for Employment

Tell Us About Yourself

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religion, marital status, sexual orientation, political belief or disability.

Federal Law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity within (3) days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

Position Applying 

Desired Salary (Per Hour)  

Date Available To Start    

First Name  

Last Name  

Middle Name


Home Phone 

Alt Phone

Date Of Birth    

Soc Sec #  


Apt #





Are you a U.S. Citizen?  

Are you athorized to work in the U.S.?  

Have you ever been convicted of a felony?  

Tell Us About Your Education
Education School Name Location # Years Graduated? Diploma/Certificate
High School
Trade School
Other School
Your Work Preferences

Please indicate the times you are available to work.

Shifts Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Mid Shifts
Are you interested in full-time or part time?  
Are you interested in management training?  
Have you ever worked for us before?  

Please list three (3) professional references you have known for at least one year.

Name       Company       Phone       Years Known      
Work History

Please list your work history, with the most current employer first.

Company 1    
Can we contact?
Company 2    
Can we contact?
Company 3    
Can we contact?

In connection with my application for employment and as a condition of continuing employment, I understand that investigative background inquiries may be made on me including previous employers, schools, consumer credit, criminal convictions, motor vehicle, and other reports. These reports will include information as to my character, work, habits, performance, education, compensation, and experience along with reasons for termination of employment from previous employers. Furthermore, I understand that the company may be requesting information from various federal, state, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences as well as claims involving me in the files of insurance companies. I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. I hereby consent to obtain the above information from Piaf and/or any of their agents. This Authorization and consent shall be valid in original, fax, or copy form.

All hiring and employment at PIAF is at will. I understand this application is not an employment contract, nor can it be used to create one. Employment by Piaf has no specific term and may be terminated by Piaf or by me with or without notice. I acknowledge that Piaf have not made any promises or representations that differ from those contained in this paragraph.

I understand I must provide satisfactory documents to establish my identity and right to work in the United States, if I am offered a position with Piaf, and that failure to provide this evidence will result in the termination of my employment.

I certify that the information I have furnished on this application form is true and complete. I understand that if any misrepresentation has been made by me verbally or in writing, any offer of employment made to me may be withdrawn or my subsequent employment with Piaf may be terminated.

Please type your full name. This is your electronic signature and by entering your full name, you agree to the statements above.