Name (Required)

Phone

Email (Required)

Street

City

State/Province

Zip/Postal Code

Position(s) applied for (Required)

Why are you seeking a new job at this time? (Required)

First Name (Required)

Middle Name

Last Name (Required)

Street Address (Required)

Social Security No.

City/State/Zip (Required)

Date of Birth (Required)

Home Phone (Required)

Cell Phone (Required)

1. If hired, do you have a reliable means of transportation to get to work? Describe (Required)

2. Are you at least 18 years old? (Required)

Yes

No

If you are under 18 years of age, can you furnish a work permit?

Yes

No

4. Are you legally eligible for employment in the U.S.? (Proof of U.S. citizenship or immigration status is required if hired.) (Required)

Yes

No

5. Have you been convicted of a crime? (Massachusetts applicants should not include misdemeanor convictions; California applicants should not include marijuana-related convictions that occurred more than 2 years prior to the application date.) (Required)

Yes

No

7. List any special skills or training: (Required)

8. Are you seeking: (Required)

Full Time

Part Time

Temporary Employment

9. What hours and shift(s) would you prefer to work? (Required)

Afternoon 11:00-4:00

Evening 4:00-close

All day 11:00-close

Morning prep only 6:00-11:00

10. List times you are not available to work? (Required)

Afternoon 11:00-4:00

Evening 4:00-close

All day 11:00-close

11. All employees are required to work holidays. Are you available to work holidays?: (Required)

YES

NO

12. Are you currently employed? (Required)

Yes

No

If yes do you intend to keep your present job

13. If hired, when would you be able to start? (Required)

14. Have you ever worked for this organization before? (Required)

If yes, name used:

15. We may conduct training or meetings on days, or at times, you have other obligations. Is your schedule flexible so you may come to training (Required)

Yes

No

16. Are you, or do you plan to be in school or taking courses at any time while working here (Required)

Yes

No

17. If you have other obligations or commitments that may affect your schedule (such as travel plans) please indicate the particular dates and times that you will be unavailable (Required)

18. How many jobs have you held in the last two years (Required)

1

2

3

4

19. List any friends or relatives employed by this company: (Required)

21. Can you perform the essential functions required by the job for which you are applying either with or without reasonable accommodations? (Required)

22. If the answer is no, please describe which tasks, if any, you will need accommodation to perform, and explain what type of accommodation you will need: (Required)

23. Do you agree not to bring into Baker’s Restaurant confidential information of any third parties that relates in any way to the restaurant industry, and to keep confidential and not disclose any of Baker’s Restaurant’s or any third parties confidential information? (Required)

Yes

No

Highschool:

Name of School

College (Required)

Name of College

If in high school, are you enrolled in a recognized co-op program? (Required)

Yes

No

1. COMPANY

Phone No. with Area Code

City/State/Zip

Dates of Employment: From -To

Salary: Beginning - Ending

Job Title

Supervisor’s Name & Title

Describe duties briefly:

Specific reason for leaving:

2. COMPANY

Phone No. with Area Code

City/State/Zip

Dates of Employment: From - To

Salary: Beginning - Ending

Job Title

Supervisor’s Name & Title

Describe duties briefly:

Specific reason for leaving:

3. COMPANY

Phone No. with Area Code

City/State/Zip

Dates of Employment: From - To

Salary: Beginning - Ending

Job Title

Supervisor’s Name & Title

Describe duties briefly:

Specific reason for leaving:

Have you attended any of the above Schools or Employment under a different name?

If so, What Name?

May we contact the above references to verify employment?

If not, specifically describe why?