Baker's Crust - A Well-Bread Restaurant

Name of School,
City, State

Year
Completed

Graduated?

Major
Study

Degree
Received

Grade
Avrg.

High School

Provide information about positions of leadership, activities, honors, and accomplishments in school, military, business, or any other information which relates to your ability to perform the position for which you are applying.

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Baker's Crust Restaurant Application - Ghent (Norfolk)

Personal Information:

First Name:		Middle Name:
Last Name:		Home Phone:
Street Address:
City:		Zip Code & State:
SSN#:		Email:

Have you ever been employed by Baker's Crust? Yes No

Are you applying for seasonal employment? Yes No

Rate of Pay Desired:

(per hour)

# of Hours Desired:

FT PT

Date you are available to begin work:

Hours Available to WorK:

Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday

Can you work overtime? Yes No

Position Applied For:

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Do you have the ability to perform the essentials of the position(s)? Yes No

Have you been convicted of a felony in the last seven years? Yes No
If yes, explain:
Are you 18 years of age or older? Yes No
If hired can you provide documentation to show you are a U.S. citizen or otherwise authorized to work in the United States? Yes No

Education:

Employment History:

Name, Address, Phone	Employment Dates	Position	Supervisor and Title	Reason for Leaving
Present/Last Position	From: To:
Previous Position	From: To:
Previous Position	From: To:
Have you ever been fired? Yes No
If yes, state employer and explain:
How were you referred to Baker's Crust for employment?
Military Service?

References

Name	Phone	Years Known

Authorization and Signature

I authorize the company to investigate thoroughly my work and personal history and verify all data given to the company. In return for being considered for a position, I release the company from any liability which might arise from such an investigation. I authorize all individuals, chools, and firms named, except my current employer if so noted, to provide any information about me, and I release them from all liability for damage in providing this information. I'm aware my first two weeks of employment will probationary. I certify that all statements herein are true and understand that any falsification or whillful omission shall be sufficient cause for dismissal or refusal of employment.
I agree to the above terms and statements.

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