Name (Last, First, M.I.)
Social Security #		- -
Address
City
State		Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Home Phone
E-mail Address
Wage Desired		$
Position Applying For		Select Job Title Counter Associate Production Staff Delivery Driver job descriptions
How did you hear about job?		Please Select One Friend Newspaper Ad Website In-Store Other
Have you ever worked for Breadsmith before?		Yes   No
If yes, give dates and locations.
Do you have the legal right to work in the USA?		Yes   No
Have you ever been convicted of a felony?		Yes   No
If yes, please explain.
Breadsmith is an equal opportunity employer, and therefore does not discriminate against any employee because of race, age, color, religion, sex, national origin, ancestry, handicap or disability, sexual orientation, marital status, off-duty use of lawful products, membership in the national guard, state defense force or any reserve component of the military forces of the United States or your nation of residence, or any other legal basis. This policy not only to employment, but to recruitment, recruitment advertising, upgrading, demotion, transfer, layoff, termination, and other matters pertaining to personal relationships.
Availability
Employment Desired		Full Time   Part Time
Please list specific days and hours available.
Total Hours Available Per Week
Any times you are unavailable to work?
Education
High School
School Name
Location
Last Grade Completed		9   10   11   12
Are you currently enrolled?		Yes   No
Have you graduated?		Yes   No
If so, when?
What is/was your GPA?
Please list any scholastic honors, sports or activities.
College or Continuing Education
School Name
Location
Last Grade Completed		1   2   3   4+
Are you currently enrolled?		Yes   No
Have you graduated?		Yes   No
If so, when?
What is/was your GPA?
Please list any scholastic honors, sports or activities.
Work History (list most recent job first) Job #1
May we contact your present employer?		Yes   No
Company
Location
Phone
Job Title
Please describe your job duties.
Supervisor's Name
Dates Worked		from to
Salary		start $ per hour year finish $ per hour year
Reason for Leaving		Quit Terminated Other
Please explain.
Job #2
Company
Location
Phone
Job Title
Please describe your job duties.
Supervisor's Name
Dates Worked		from to
Salary		start $ per hour year finish $ per hour year
Reason for Leaving		Quit Terminated Other
Please explain.
Job #3
Company
Location
Phone
Job Title
Please describe your job duties.
Supervisor's Name
Dates Worked		from to
Salary		start $ per hour year finish $ per hour year
Reason for Leaving		Quit Terminated Other
Please explain.
Physical Requirements
A manager will describe for you the essential duties of the job for which you are applying. At that time you may discuss any accommodations you need to perform those job functions.
1. I hereby certify that all above questions are fully and correctly answered. I understand that any misleading or incorrect statements made as part of this application may be considered cause for rejection or dismissal. 2. I also grant Breadsmith to establish my employment eligibility through inquiry of past employment and education and agree to release from liability all persons supplying such information. 3. If employed, I agree to conform to the rules and policies of Breadsmith and that at anytime I will be free to resign for any reason and that Breadsmith also holds the same right to terminate my employment at will. I understand that no representative of Breadsmith other than the store owner, has the authority to enter into any agreement for employment for any specified time or to make any agreement contrary to the foregoing.

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