Dominos Pizza - Bullhead City, AZ
Job Application

Personal Information

First Name :  
Last Name:  
Date of Birth:
Home Address - Street:  
Home Address - City:  
Home Address - State:  
Home Address - Zip:
Contact Phone No.:
Email Address:  
Where did you hear about the job?
Box Topper Internet Employment Agency
Referred by current team member Store banner Worked for Domino's previously
Walk-in Newspaper Ad Other
A good attendance record is important at Domino's. Is there anything that would force you to be consistently late?
Yes No   If yes, please explain:
 
Position & Availability
All employees are required to work at least one weekend night What is the maximum hours you can work?
Position Applied for
Date you can start
Are you currently employed? Yes   No
  Mon Tue Wed Thu Fri Sat Sun
From
To
Do you plan to keep working there if you work for Domino's? Yes No
 
Employment Record
Please list all previous employers, starting with the most recent. If you have previously worked for Domino's, please write the store location.
 
Name of current / previous employer Job Title
Address Starting Date
Name and title of supervisor    
May we contact the supervisor Yes No Phone No.
Reason for leaving    
 
Car Details
All personnel involved in product delivery for Domino's Pizza must have their licenses and registration reviewed before beginning employment and every 120 days thereafter. In addition, all team members must meet the following requirements:
 
  • No team member will be allowed to drive any vehicle for Domino's Pizza without a valid driver's license from the state of their primary residence. Licenses must be in good standing (i.e. not suspended, revoked or restricted)
  • Individuals must show proof of and maintain comprehensive third party car insurance or agree to use Domino's delivery driver insurance policy through payroll deductions. A letter from your insurance company that states your car is covered by your private policy while delivering pizzas, along with a copy of your policy is ample proof.
  • All vehicles used for delivery or other company business must pass a safety inspection.
  • No one may be hired into a position which requires driving unless their driving record meets Domino's Standards.
State License was issued License Number
Date from which you held a valid license License expiry date
Vehicle Make Model
Year Registration Number
Do you have any charges pending against you for any traffic violation which could see your license being suspended, revoked or restricted?   Yes No (A 'yes' answer does not automatically disqualify you from further consideration)
If yes, please explain:
 
Declaration
I certify the facts contained in this application are true and complete. I understand that, if employed, false statements or omissions on this application are grounds for dismissal. I acknowledge that I have read and agree to comply with every aspect or the job description and the uniform standards listed on this application form should I be employed. I give my authorization to verify all information provided in this application.