PARLOR DOUGHNUTS INDIANAPOLIS

PARLOR DOUGHNUTS INDIANAPOLIS

IUPUI
Thank you for your interest in employment with Parlor Doughnuts in Indianapolis.

Please complete all sections of the application form so that your qualifications may be fully considered It is the policy of Parlor Doughnuts to be in full compliance with all applicable federal and state non-discrimination and equal opportunity laws and regulations relating to race, color, sex, religion, disability, age, national origin, veteran status, or any other category protected under federal, state or local law.
Position(s) or Department(s) Desired*
Date Available*

MonthDayYear
Date
Name (Last)*
Name (First)*
Address: (Street)*
Address: (City)*
Address (State)*
Zip Code*
Cell Phone #:*
Please enter a valid phone number.
Email Address*
example@example.com
Hourly Wage desired
Are you 18 years of age or older? (Individuals who are 14-17 years of age may be required to provide a work permit.)*
Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment)*
If answering no, please explain
I am seeking (check all that are applicable):*

Full Time EmploymentPart Time Employment
I am willing to work (check all that are applicable): Rotating Shifts Weekends*

Early MorningsAfternoonsRotating ShiftsWeekendsOvertime
If you need to work around another schedule (e.g. school, sports, etc), please provide any details that need to be coordinated/considered

Education

Educational History

	Name, City, State	Years Completed	Degree	Course of Study
High School
Business / Vocational School
College
Other

Indicate any other technology skills you possess that would be applicable for the position, including Point of Sale (POS) systems:
Summarize special skills/qualifications or other experience that may qualify you to work Parlor Doughnuts. (Exclude those which indicate race, color, sex, religion, disability, age, national origin, or any other protected category.)*
Do you speak a second language?*

YesNo
If yes, please list

Employment History
Beginning with your current / most recent employment, please complete the section below in full. Incomplete information could disqualify you from further consideration.

Company #1 & 2*

	Company #1	Company #2
Company Name
Job Title
Date Range of Employment
Address
City / State / Zip
Final Salary or Hourly Wage
Supervisor Name
Supervisor Phone Number
Email
Duties
Reason for Leaving
Amount of Notice Given

Company #3 & 4

	Company #3	Company #4
Company Name
Job Title
Date Range of Employment
Address
City / State / Zip
Final Salary or Hourly Wage
Supervisor Name
Supervisor Phone Number
Email
Duties
Reason for Leaving
Amount of Notice Given

Have you ever been discharged from a position or asked to resign from a position in lieu of being discharged?*

YesNo
If yes, please explain

Professional References
List individuals who can provide information about your employment, volunteer activities, or professional experiences (do not list relatives). Please do not list supervisors who have already been identified on the previous page.

Professional Reference #1*

	Reference #1 Information
Name
Company
Occupation / Relationship
Number of Years Known
Phone Number
Email

Professional Reference #2

	Reference #2 Information
Name
Company
Occupation / Relationship
Number of Years Known
Phone Number
Email

Professional Reference #3

	Reference #3 Information
Name
Company
Occupation / Relationship
Number of Years Known
Phone Number
Email

Applicant Certification & Agreement

In exchange for the consideration of my job application with the Company, I agree that:
* (initials) I agree, if am offered and accept a position, to conform to all existing and future Company rules and regulations, I understand that Company reserves the right to change wages, hours and working conditions as deemed necessary.
blanks* (initials) I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others about me as deemed appropriate by the Company, and hereby release the Company from any liability as a result of such contract.
blanks* (initials) I understand that any employment offer is contingent upon my providing, within three working days of valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.
blanks* (initials) I have read and reviewed the information provided in this application and the above statements. I certify that the facts and information set forth in this application, are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on the application, resume and any attachments (or on any required document) will be cause for denial of employment or termination of employment, regardless of when or how it was discovered.
Signature*

Clear
Printed Name*
Date*

MonthDayYear
Date
Please upload any additional documentation you would like our management to review. (Resume, Cover Letter, etc.)

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PARLOR DOUGHNUTS INDIANAPOLIS

Education

Employment History

Professional References

Applicant Certification & Agreement