DATE:___________
EMPLO YMENTA PPLIC A TIO N
(AN EQ UAL O PPO RTUNITY EMPLO YER)
85°C BAKERY C AFE is a n e q ua l e mp lo yme nt o p p o rtunity e mp lo ye r. We c o mp ly with fe d e ra l sta te a nd lo c a l la ws re g a rd ing e q ua l e mp lo yme nt o p p o rtunity. Q ua lifie d a p p lic a nts a re c o nsid e re d fo r p o sitio ns witho ut re g a rd to ra c e , c o lo r, na tio na l o rig in, re lig io us b e lie fs, se x, p re g na nc y, a g e ,
d isa b ility, se xua l o rie nta tio n, c itize nship sta tus, milita ry sta tus o r a ny o the r b a sis p ro te c te d b y
fe d e ra l, sta te a nd / o r fa ir e m p lo ym e nt la ws.
We use E- Ve rify to va lid a te e m p lo ym e nt e lig ib ility
http s:/ / www .d hs.g o v/ E-Ve rify
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StreetCity State Zip
Ho me Pho ne : _____________________________ Mo b ile Pho ne :_____________________________
EMAIL:________________________________________________________________________________
* Are yo u o ve r 18 ye a rs o f a g e ? ___ Ye s ___ No
*Q ue stio ns a p p lic a b le o nly if la w re q uire s tha t yo u b e o f minim um a g e fo r the p o sitio n fo r whic h yo u a re a p p lying
Ha ve yo u e ve r b e e n c o nvic te d o f a ny c rim e in the la st five (5) ye a rs? : ___ Ye s ___ No If ye s, whe n, whe re a nd o utc o me / d isp o sitio n?
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(C o nvic tio n o f a c rime will no t ne c e ssa rily disq ua lify a n a p p lic a nt fro m c o nside ra tio n fo r e mp lo yme nt.)
WO RK EXPERIENC E
Po sitio n a p p lying fo r: ________________________ Lo c a tio n a p p lying fo r: ____________________
Da te Ava ila b le : __________________ (Ple a se C irc le O ne ): Full Time / Pa rt Time / Se a so na l
Wha t skills a nd e xp e rie nc e c a n yo u b ring to this p o sitio n, whic h yo u fe e l mig ht b e he lp ful?
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85°C Ba ke ry C a fe o p e ra te s se ve n (7) d a ys a we e k.
Ple a se list a ll time s tha t yo u wo uld b e a va ila b le fo r wo rk, if o ffe re d e mp lo yme nt with the c o mp a ny.
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TO TAL HO URS AVAIABLE PER WEEK: _____________ |
Ha ve yo u e ve r b e e n e mp lo ye d b y the c o mp a ny o r a ny o the r 85°C Ba ke ry C a fe
lo c a tio n? ___ Ye s ___ No
If ye s, p le a se sta te whe n a nd lo c a tio n:__________________ Jo b Title :____________
EMPLO YMENTHISTO RY
Sta rt with yo ur p re se nt o r m o st re c e nt e m p lo ye r. Ple a se fill o ut c o m p le te ly.
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Ma y we c o nta c t yo ur Pre se nt Emp lo ye r? ___ Ye s ___ No
If no t, ind ic a te b y NUMBER whic h o ne (s) yo u d o no t wish us to c o nta c t: __________
EDUC A TIO N A ND TRA INING
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REFERENC E
Who re fe rre d yo u fo r a p o sitio n with 85°C Ba ke ry & C a fe o r ho w d id yo u he a r a b o ut us?
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Ple a se list two (2) re fe re nc e s:
Na me :
C o mp a ny:Pho ne :
Ad d re ss:
C ity/ Sta te / Zip
Te ll ho w yo u kno w this p e rso n a nd fo r ho w lo ng :
Na me :
C o mp a ny:Pho ne :
Ad d re ss:
C ity/ Sta te / Zip
Te ll ho w yo u kno w this p e rso n a nd fo r ho w lo ng :
PLEA SE REA D C A REFULLY:
In the e ve nt o f my e mp lo yme nt with 85°C Ba ke ry C a fe , I a g re e tha t:
1. In the e ve nt o f e mp lo yme nt, I und e rsta nd tha t a ny misre p re se nta tio n b y me in this a p p lic a tio n will b e suffic ie nt c a use fo r c a nc e lla tio n o f this a p p lic a tio n a nd / o r fo r
se p a ra tio n fro m the C o mp a ny’ s se rvic e .
2.My e mp lo yme nt ma y b e te rmina te d b y 85°C Ba ke ry C a fe a t a ny time witho ut p rio r no tic e a nd with o r witho ut c a use .
3.85°C Ba ke ry C a fe ma y re q ue st e a c h e m p lo ye r, p e rso n, c o mp a ny o r sc ho o l na me d
a b o ve to a nswe r a ll q ue stio ns tha t ma y b e a ske d a nd to g ive a ll info rm a tio n tha t ma y b e so ug ht in c o nne c tio n with this a p p lic a tio n o r c o nc e rning me o r my wo rk ha b its,
c ha ra c te r, skill o r a c tio n in a ny tra nsa c tio n.
Ic e rtify tha t a ll my sta te m e nts ma d e in this a p p lic a tio n a re true . If o ffe re d e mp lo yme nt, yo u will b e no tifie d o f the p ro o f yo u must sub m it to the C o mp a ny to e sta b lish yo ur rig ht to wo rk in the Unite d Sta te s.
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Sig na ture o f Ap p lic a nt |
Da te |
No te s (O ffic e Use ):
A LL INFO RMA TIO N WILL BE KEPTC O NFIDENTIA L.
OFFICE USE ONLY:
Interviewer Signature___________________________________ Date: ________________
Date Hired: _____________Starting Salary: $___________ per __________ Position___________
Store No. _____________ Start Date: __________________________________________________
a utho riza tio n must b e re q ue ste d e a c h time a re p o rt is o rd e re d . - C A C iv.
Em p lo ye e Re le a se
AU TH ORI Z ATI ON AN D RELEASE TO OBTAI N I N FORM ATI ON
Und e r the p ro visio ns o f the Fa ir C re d it Re p o rting Ac t, 15 USC , Se c tio n 1681 e t se q ., the Ame ric a ns with Disa b ilitie s Ac t a nd a ll a p p lic a b le fe d e ra l, sta te , a nd lo c a l la ws, I he re b y a utho rize a nd p e rmit to o b ta in a c o nsume r re p o rt a nd / o r a n inve stig a tive c o nsume r
re p o rt whic h ma y inc lud e the fo llo wing :
1.My e mp lo yme nt re c o rd s;
2.Re c o rd s c o nc e rning a ny d riving , c rimina l histo ry, c re d it histo ry, c ivil re c o rd , wo rke rs’ c o mp e nsa tio n (p o st-o ffe r o nly) a nd d rug te sting ;
3.(Fo r truc k d rive rs o nly) In a c c o rd a nc e with the De p a rtme nt o f Tra nsp o rta tio n Mo to r C a rrie r Sa fe ty Re g ula tio ns, Se c tio n 382.413, info rm a tio n c o nc e rning a lc o ho l a nd
c o ntro lle d sub sta nc e s fo r the p a st 3 ye a rs;
4. Ve rific a tio n o f my a c a d e mic a nd / o r p ro fe ssio na l c re d e ntia ls; a nd info rma tio n a nd / o r c o p ie s o f d o c ume nts fro m a ny milita ry se rvic e re c o rd s.
I und e rsta nd tha t a n “ inve stig a tive c o nsume r re p o rt” ma y inc lud e info rm a tio n a s to my c ha ra c te r, g e ne ra l re p uta tio n, p e rso na l c ha ra c te ristic s, a nd mo d e o f living , whic h ma y b e o b ta ine d b y inte rvie ws with ind ivid ua ls with who m I a m a c q ua inte d o r who ma y ha ve kno wle d g e c o nc e rning a ny suc h ite m s o f info rma tio n.
I a g re e tha t a c o p y o f this a utho riza tio n ha s the sa me e ffe c t a s a n o rig ina l.
I he re b y re le a se a nd ho ld ha rmle ss a ny p e rso n, firm , o r e ntity tha t d isc lo se s ma tte rs in
a c c o rd a nc e with this a utho riza tio n, a s we ll a s fro m lia b ility tha t mig ht o the rwise re sult fro m the re q ue st fo r use o f a nd / o r d isc lo sure o f a ny o r a ll o f the fo re g o ing info rma tio n.
I und e rsta nd a nd a c kno wle d g e tha t und e r p ro visio n o f the Fa ir C re d it Re p o rting Ac t I ma y re q ue st a c o p y o f a ny c o nsume r re p o rt fro m the c o nsume r re p o rting a g e nc y tha t c o mp ile d the re p o rt, a fte r I ha ve p ro vid e d p ro p e r id e ntific a tio n.
I he re b y a utho rize to o b ta in a nd p re p a re a n inve stig a tive c o nsume r re p o rt a s se t fo rth
a b o ve , a s p a rt o f its inve stig a tio n o f my e mp lo yme nt a p p lic a tio n. This a utho riza tio n sha ll re ma in in e ffe c t o ve r the c o urse o f my e m p lo yme nt. Re p o rts ma y b e o rd e re d p e rio d ic a lly d uring the c o urse o f my e mp lo yme nt. NO TE: Exc e p t fo r tho se sta te s whe re a n a nnua l
re le a se is re q uire d , i.e . C a lifo rnia (C ALIFO RNIA – C o ntinuing c o nse nt c o nc e p t is ina p p lic a b le a nd a se p a ra te
C o d e 1786.22)
Full Na me |
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Sig na ture : |
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