Application

Applicant Legal Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Who were you referred by? *

Have you ever eaten at Rediviva? Tell us about your experience! *

Have you previously worked at Rediviva or Frontager's Pizza Co? *

Are you under the age of 18? *

Are you legally eligible for employment in this country? *

Tell us about your hobbies? *

Date available to start working with us? *

What current or future obligations affect your ability to work (other commitments, another job, school, sports, vacations, etc)? *

May we contact your current employer? *

Yes No Not working at this time

Previous Experience: Please list your latest three employers (most recent first). Do not write “see resume.”* Please list: Employer, Contact Name, Phone Number, Position Held, Dates of Employment & Reason for Leaving for each Employer *

Applicant Declaration (Type in Your Name)* I expressly authorize Rediviva and/or its representatives to contact my previous employers or other persons to verify and obtain any information concerning me. I certify that the information I have provided is true. I understand that providing misleading or false information may exclude me from hire, or if hired, may result in my discharge. I understand that completion of this application does not guarantee an interview or employment. I understand that Rediviva Restaurant is an Equal Opportunity Employer, and that the information contained in this application will not be used to discriminate against me on any basis prohibited by law. Rediviva Restaurant is an E-Verify Employer. *

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Rediviva
118 E. Wishkah Street
Aberdeen, WA 98520

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