Application
for employment
Position(s) desired__________________________
Lucullan's
Italian Grill
400 Main
* Ames, Iowa * 50010 * 232-8484
Do not waste your time
completing this application until you have read our profile to see if you qualify to work.
Name____________________________Phone #_____________Cell #___________________Date__________
Street Address_____________________________________________City_______________________________
Address to send W-2_________________________________________________________________________
E-mail address_________________________________________
Emergency contact: Name____________________________________Phone_____________________
Social Security Number_________________________________Are you over 21?_____
Who do you know that works here?____________________________________________________________
Pay range_______________
1. Do you have any physical ailments that could be aggravated by work
or prevent you from doing this job? Explain________________________________________________________________________________________
2. Do you have any time-off requirements? for weddings? holidays? vacations? explain________________________________________________________________________________________
3. Do you have a lease in your name?_________Expires_______
4. By signing this application you will be making a minimum of a one year
commitment to this job: O.K.______Not O.K.______
5. When do you plan to leave Ames?______________________
6. What is the longest job held?
Explain___________________
7. How many hours/shifts do you want?_______________________________________________________________
8. Please write your schedule on the back of the application.
Work References:
Most recent employer_______________________________________Supervisor_______________________________
Phone number__________________________________________________City/State___________________________
Worked from_____/______ to ______/_______ Job title____________________________
Ending pay__________Reason for leaving________________________________
Restaurant/other employer _________________________________Supervisor________________________________
Phone number____________________________________________City/State_________________________________
Worked from_____/______ to ______/_______ Job title___________________________
Ending pay__________Reason for leaving_______________________________
The facts set forth in my application for employment are true and complete. I
understand that if employed, false statements on this application may lead to termination.
I authorize investigation of all statements contained herein, and grant permission for release of information from
previous employers and references.
Signed_____________________________________________________
Dated___________________
Be sure to complete the reverse side of the application!
Please write
your class schedule plus any other on-going conflicts here.
Friday
Saturday Sunday Monday Tuesday Wednesday Thursday
8:00___________________________________________________________________
9:00___________________________________________________________________
10:00__________________________________________________________________
11:00__________________________________________________________________
12:00__________________________________________________________________
1:10___________________________________________________________________
2:10___________________________________________________________________
3:10___________________________________________________________________
4:10___________________________________________________________________
5:00___________________________________________________________________
6:00___________________________________________________________________
7:00___________________________________________________________________
8:00___________________________________________________________________
We have certain times that require our entire crew to work. I hire specifically
to cover these times. Please indicate if you are available.
Available
All ISU Graduations (Mid May, Early Aug. & Mid Dec.)
yes no
Mother's Day (2nd Sunday in May) yes no
ISU Parent's Weekend yes no
Valentine's Weekend, February 14+ yes no
New Year's Eve yes no
I will be available for a minimum of one year yes no
I will be here for the summer. yes no
I will be here for spring break. yes no
I will be here for fall break. yes no
I have read the above and understand that I cannot schedule conflicts with the times listed above if I have indicated
that I am available.
Signed________________________________________________________Dated_________________________