Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date Available *

MM

DD

YYYY

Are you at least 18 years of age? *

Yes

No

Are you a citizen of the United States? *

Yes

No

If no, are you authorized to work in the U.S.? *

Yes

No

Have you ever been convicted of a felony? *

Yes

No

Did you graduate?

Yes

No

Did you graduate?

Yes

No

Did you graduate?

Yes

No

Name of Reference *

First Name

Last Name

Phone *

(###)

###

####

Name of Reference *

First Name

Last Name

Phone *

(###)

###

####

Name of Reference *

First Name

Last Name

Phone *

(###)

###

####

Phone

(###)

###

####

May we contact your previous supervisor for a reference?

Yes

No

Phone

(###)

###

####

May we contact your previous supervisor for a reference?

Yes

No

Phone

(###)

###

####

May we contact your previous supervisor for a reference?

Yes

No

DISCLAIMER *

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary. I agree that all work product for AMIE Bakery is owned by and is proprietary to AMIE bakery. I further agree not to accept employment with any bakery or direct competitors within a (5) five-mile radius of AMIE Bakery for (1) one year after last day of employment. I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information about me and all other persons, corporations or organizations for furnishing such information.

I have read and understood the disclaimer above.

TODAY'S DATE *

MM

DD

YYYY