Employment Application | Diamond City Bread

Personal Information:

Last Name	Middle	First	Date
Street Address		City	State
Home Phone	Alternate Phone	Are you 18 years old or over? Yes No

Position Desired:

Position Desired	Date Available	Desired Wage
Days Available M Tu W Th F Sa
Please list your hours of availability for each day
Full Time Part Time Temporary Other
What prompted your application? Ad Employee Referral Other
Have you ever applied here before? Yes No	If yes, give a date
Can you, after employment, submit verification of your identity and legal right to work in the United States? Yes No		If you are not a citizen, what is your visa status?
Have you ever been convicted of a felony? (Do not include convictions that have been sealed, expunged, or statutorily eradicated.) Yes No

Education:

High School	College/University	College/University
Name:	Name:	Name:
Location:	Location:	Location:
Major:	Major:	Major:
Degree:	Degree:	Degree:

Experience:

	Present or Most Recent Employer	Previous Employer	Previous Employer
Company
Address
Supervisor Name
Phone #
May we Contact? (circle one)	Yes No	Yes No	Yes No
Your Job Title
Date of Employment?
Starting Salary?
Ending Salary?
Reason for Leaving?

Skills:

Explain any skills and/or list additional aptitudes, experiences, courses you have completed, or affiliations which you feel could qualify you for the type of work you seek with Diamond City Bread.

References:

Reference 1	Reference 2	Reference 3
Name:	Name:	Name:
Address:	Address:	Address:
Phone #:	Phone #:	Phone #:
Relationship:	Relationship:	Relationship:

I hereby attest the above information to be true and correct. I understand that any information found to be false will be considered grounds for dismissal. I agree to comply with company standards and agree that my employment can be terminated with or without cause and without notice at any time at either my or the company's option. This application will expire after one year from the date on the front side.

Signature of Applicant

Date

Application for Employment