Wufoo

Name First Last
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Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

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Home Phone ### - ### - ####
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Cell Phone ### - ### - ####
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Email

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Social Security Number

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Have you ever been employed in any Bruegger's Bakery?
Yes No

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If so, location and dates of employment

Please state, the location and dates of employment, of your previous Bruegger's Bakery job.
Position Sought

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Part Time Full Time

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How soon can you start work?

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Are you over 18 years old?
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Are you legally eligible for employment in the United States?

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When would you be able to start work?

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Total Hours available per week?

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Desired Wage

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Available days to work
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Please check the days that you are able to work. If there are restrictions such as school that keep you from being available certain hours of those days you checked, please tell us below.
Restrictions for days checked above

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How did you hear about us?

Please tell us how you heard about our bakery.
Who referred you?

Please list the name of the person that referred you to our bakery.
Please list any restaurant experience you have and what your duties and responsibilities were.
Education

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High School

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Did you graduate?
Yes No Still attending

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College and/or Vocational School

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Number of Years Completed

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Did you graduate?
Yes No Still attending
Major

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Professional License or Membership

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Type of License(s) Held

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State and License Number

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License Expiration Date

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Other Professional Memberships

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Please describe your skills here.
Record of Conviction
During the last ten years, have you been convicted of a crime other than a minor traffic offense?
Yes No

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If yes, explain:

(A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered).
Employment

List last employer first, including U.S. Military Service.
May we contact your present employer?
Yes No

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Present or Most Recent Employer.
Employer

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Address

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Phone ### - ### - ####
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Position

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Starting Date of Employment MM / DD / YYYY
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Ending Date of Employment MM / DD / YYYY
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Salary (hourly)

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Supervisor

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Department

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Duties

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Reason for Leaving

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Second Employer
Employer

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Address

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Phone ### - ### - ####
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Position

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Starting Date of Employment MM / DD / YYYY
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Ending Date of Employment MM / DD / YYYY
Please enter the date that you stopped working for the employer.
Salary (hourly)

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Supervisor

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Department

Please enter the deparment you worked in at the employer. Leave blank if there was just one department at your employer.
Duties

Please list and explain the duties you had at your job.
Reason for Leaving

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Third Employer
Employer

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Address

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Phone ### - ### - ####
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Position

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Starting Date of Employment MM / DD / YYYY
Please enter the date you started working for the employer.
Ending Date of Employment MM / DD / YYYY
Please enter the date that you stopped working for the employer.
Salary (hourly)

Please enter your what you were making (per hour) at the employer.
Supervisor

Please enter the name of your supervisor.
Department

Please enter the deparment you worked in at the employer. Leave blank if there was just one department at your employer.
Duties

Please list and explain the duties you had at your job.
Reason for Leaving

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References
Professional Reference 1
Name First Last
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Address

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Phone ### - ### - ####
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Professional Reference 2
Name First Last
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Address

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Phone ### - ### - ####
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Personal Reference 3
Name First Last
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Address

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Phone ### - ### - ####
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Personal Reference 4
Name First Last
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Address

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Phone ### - ### - ####
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Applicant's Certification and Agreement

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize North Coast Bakeries, Inc. to verify their accuracy and to obtain reference information on my work performance.

I hereby release North Coast Bakeries, Inc. from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract.

I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.

I understand that the Company requires the successful completion of a urinalysis for drug testing purposes and/or a blood alcohol test as a condition of employment. By submitting this Application for Employment, I hereby consent to either or both of said tests, at the Company’s discretion.
Electronic Signature of Applicant

Please enter your full name here after reading the terms above.
Date MM / DD / YYYY
Release and Authorization for Background and Reference Investigation

In connection with my application for employment (including contract for services), I understand that investigative background inquiries are to be made on me which may include criminal convictions, motor vehicle, and other reports. These reports may include information as to my character, work habits, performance, education and experience along with reasons for termination of employment from previous employers. Further, I understand that you will be requesting information from various Federal, State, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil and other experiences. If I include a current employer for verification, I may jeopardize my position within that company.

I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from any liability and responsibility for doing so. This authorization and consent shall be valid in original, fax or copy form. I further authorize ongoing procurement of the above-mentioned reports at any time during my employment (or contract).

I am aware that the result of any background investigation performed by Employer and/or its designees is not the sole criteria used by the Employer in making a decision to hire or not hire any individual, including me. I am also aware that any falsification or misrepresentation of information appearing on my application for employment shall be grounds for my not being hired or for my being terminated.

I have carefully read this Release and Authorization for Background and Reference Investigation and have voluntarily agreed to its terms to assist Employer in evaluating my qualifications for employment and in meeting the business necessity of hiring honest, trustworthy, reliable, and non-violent employees. I additionally agree to fully cooperate with Employer in permitting the release of the above information and reports. Finally, I understand that with the exception of any credit reports, all information generated, received or maintained during or as a result of its investigation, will be maintained as confidential information and that Employer will not release such information to me.
Electronic Signature of Applicant

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Date MM / DD / YYYY
Please click the submit button ONCE and allow a couple minutes for your application to be submitted. Thank You.
Do Not Fill This Out

Wufoo

Education

Professional License or Membership

Record of Conviction

Employment

Present or Most Recent Employer.

Second Employer

Third Employer

References

Professional Reference 1

Professional Reference 2

Personal Reference 3

Personal Reference 4

Applicant's Certification and Agreement

Release and Authorization for Background and Reference Investigation

Please click the submit button ONCE and allow a couple minutes for your application to be submitted. Thank You.