Gumby’s Team Member Application
Date Received: ______________________
Position Applied For:
____ Driver ____ Cook _____ Cashier/Counter ____ Management
____ Part Time ____ Full Time
Name: ________________________________________________ Phone #: ____________________________________
Address: __________________________________________________ City: _____________________ Zip:__________
Are you Eligible for employment in the US? Yes / No
Are you 18 years or older? Yes / No
 Do you have a reliable way to get to work? Yes / No
Have you ever been disciplined for cash handling violations? Yes / No
 Have you been convicted of a misdemeanor or a Felony in the past 10 years? Yes / No
If you answered yes to either of the last two questions please explain in the area below.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Availability
Monday
From
Tuesday
To
From
To
Wednesday
Thursday
Friday
From
From
From
To
To
To
Saturday
Sunday
From
From
To
to
If offered a position on our team, how long do you expect to work here? _____________________________
Gumby’s is open late; will working till 4am be a problem? _____________________________________________
How many hours per week are you looking to work? ___________________________________________________
Education
High School/College
Location
City, State
Last Year
Attended
Graduated
Degree
Yes / No
Yes / No
Yes / No
Work Experience
Company Name
Position
Dates Employed
Ending Wage
Address
Supervisor
From
Reason for leaving
City, St
Supervisor’s Phone
To
Company Name
Position
Dates Employed
Ending Wage
Address
Supervisor
From
Reason for leaving
City, St
Supervisor’s Phone
To
Company Name
Position
Dates Employed
Ending Wage
Address
Supervisor
From
Reason for leaving
City, St
Supervisor’s Phone
To
Personal References
Name (Do not list relatives)
Phone Number
Relationship
Tell us why you’d be a great Gumby’s Team Member. Please list any special skills/education or training;
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Tell us about your favorite pizza. Please describe or illustrate it for us. (Feel free to use the back.)
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Authorization
Gumby’s of San Marcos LLC. Is an Equal Opportunity Employer. Any person applying for a position with Gumby’s will be
considered for the position for which they have applied without regard to race, religion, age, sex national origin or disability.
I certify that all statements made in this application are true and complete and authorize Gumby’s Pizza of San Marcos LLC to
investigate all statements made from all prior employers, references and law enforcement agencies. I hereby release all those
persons, employers, references, agencies and Gumby’s of San Marcos LLC from any and all liability arising from their giving or
receiving information about my employment history, qualifications, or criminal record. I further authorize Gumby’s of San
Marcos LLC to conduct whatever background checks are necessary to either verify information provided by me on this
application or in interviews relating to prospective employment, or to verify any material change in my background
subsequent to my employment.
I understand that any false answers or statements or misrepresentations by omission made by me as a part of my application
will be sufficient for rejection of my application or for my immediate discharge should one be discovered after I am employed.
I understand that nothing in this employment application, in Gumby’s of San Marcos LLC’s statements of personnel policies or
in my communication with any employee or official is intended to create an employment contract between Gumby’s of San
Marcos LLC and me, and that my employment with the company was entered into voluntarily and that I may resign at any
time. Similarly, my employment may be terminated with or without cause at any time without prior notice.
I herby acknowledge that I have read and understand the preceding statement.
Signature: _________________________________________________________ Date: ___________________________
Driving Information
Current Drivers Licenses Number: _____________________ State: _____ Date of Birth: __________________
List any other Drivers Licenses held in the last 2 years, Number: ____________________ State: _____
Auto Insurance Company: _____________________________________________________________________
Policy Number: _________________________________ Effective: ________________ Exp. Date: ________________
Have you had at least 6 months driving experience in the US? Yes / NO
Have you ever been convicted of a crime involving a motor vehicle, including vehicular homicide
or assault? Yes / No If Yes explain: ________________________________________________
In the last 5 years, have you ever received a violation for DUI/DWI/open container/chemical test
failure/possession of a controlled substance? Yes / No
In the last 5 years have you ever received a violation for any of the following; Hit & Run, Speed
Contest/Racing, Driving on a Suspended/Revoked License, Eluding a Police Office, Distracted
Driving: i.e. cell phone use or texting violations? Yes / No
Has your driver’s license ever been suspended or revoked? Yes / No
If Yes explain:
_________________________________________________________________________________________________________________
Vehicles, which will be used on the Job:
Make: ___________________ Model: _______________ Yr: _________ License #: _________________ State: _________
Make: ___________________ Model: _______________ Yr: _________ License #: _________________ State: _________
If you are employed as a delivery driver by Gumby’s Pizza of San Marcos LLC, then you are required to
maintain personal Auto Liability insurance at the mandatory state liability limits for Texas. You shall also
be solely responsible for maintaining at your cost, such comprehensive and auto collision coverage, as
you deem necessary to cover your vehicle. Gumby’s Pizza is not responsible for, and you assume all risk
of, any loss, theft, vandalism, or property damage to your vehicle and contents while being used in
connection with your employment with Gumby’s Pizza. You will be required to provide Gumby’s Pizza
with a valid copy of your insurance policy or declaration page and proof of premium payment when you
are hired and again upon each renewal. We reserve the right, and you authorize Gumby’s Pizza or its
agents, to contact your insurance agent and/or carrier either verbally or in writing, or both, to confirm
the type and amount of your coverage’s and that the premiums have been paid. In addition, your motor
vehicle report will be checked, at the time of application and periodically thereafter, to verify
your driving eligibility, and this serves as our authorization to do so.
I hereby acknowledge that I have read and understand the preceding statement.
Signature: ________________________________________________ Date: _______________________________