APPLICATION FOR EMPLOYMENT

Please fill in giving complete answers to all items which apply.

 

It is the policy of this company to give equal opportunity to all qualified applicants.  All employment practices provide that individuals be recruited, hired, assigned, advanced, compensated and retained on the basis of their qualifications and treated equally without regard to race, color, creed, national origin, age or gender.

 

PERSONAL:                                                                DATE: _______________________

 

Name____________ _______________________________  Social Security #_______________________________

               Last                         First              Middle Initial

 

Present Address ________________________________________________________________________________

                                    No.         Street                   City              State        Zip              Telephone No. 

 

How did you learn of this opening? _________________________________________________________________

 

Have you worked for us before?  __________________   If so, when? _____________________________________

 

EDUCATIONAL BACKGROUND:

 

                             Name and Address       # of Years Completed   Courses or Major         Diploma or Degree

 

High School          _____________________________________________________

 

College                  _____________________________________________________

 

Post Graduate         ______________________________________________________________

 

Business/Trade     _____________________________________________________

 

Other                       _____________________________________________________________

 

MILITARY SERVICE RECORD

 

Have you ever served in the armed forces? ______ If yes, what branch?____________________

 

Dates of Duty:   From ____________  To ____________ Rank at Discharge ________________

 

Current Reserve Obligation?  ______________________________________________________

 

Nature of Duties: ________________________________________________________________

 

Duties that would apply to a position at Dudley’s: _______________________________________

 

 

 

 

EMPLOYMENT HISTORY:  Please list most current first and then back in order

 

                                                Address (City, Street, State)                  Start Date         Month, Year      Base Pay

 

Employer______________________________________________________________________

Name and Title of Supervisor                                                        End Date          Month, Year      Base Pay

 

Your position and duties                                                                Reason for leaving

_____________________________________________________________________________________________

 

                                                Address (City, Street, State)                  Start Date         Month, Year      Base Pay

 

Employer______________________________________________________________________

Name and Title of Supervisor                                                        End Date          Month, Year      Base Pay

 

Your position and duties                                                                Reason for leaving

_____________________________________________________________________________________________

 

                                                Address (City, Street, State)                  Start Date         Month, Year      Base Pay

 

Employer______________________________________________________________________

Name and Title of Supervisor                                                        End Date          Month, Year      Base Pay

 

Your position and duties                                                                Reason for leaving

 

 

May we contact the employers listed above?__________  If not, indicate below which ones you do not wish us to contact:

 

 

What special skills do you have? ___________________________________________________

 

Please list any other experiences or qualifications which you feel would benefit our company should you be hired:

 

PLEASE READ CAREFULLY

 

I understand that Dudley’s Famous Bakery & Deli, LLC is a drug free environment and random drug testing may occur to ensure compliance, any refusal to cooperate shall result in immediate termination of employment.  I additionally understand all persons are hired on a 90 day probationary period and may be terminated during this period with or without reason, at the company’s sole discretion.

I hereby certify that the answers given and statements made are true and correct.  I hereby authorize all my previous employers or references to furnish any information concerning my educational or employment records.  You may make investigation through credit and other investigating agencies.  I hereby release all such persons from liability or damages incurred as a result of inquiry and furnishing this information. 

 

 

____________________________________               ___________________________________

Witness (company interviewer)                                                               Applicant’s signature