Harvest Valley Bakery, Inc. Job Application

Harvest Valley Bakery, Inc.

348 N. Civic Rd La Salle, Illinois 61301 - 815224-9030

Harvest Valley Bakery is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all of the sections below
Applicant Information
Name*

First NameLast Name
Address*

Address

Street Address Line 2

City, State and Zip CodeState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date of Application*

MonthDayYear
Date
Employment Position
Position(s) applying for:*
Full timePart time
YesNo
How did you hear about this position?*
What days are you available for work?*
What hours or shift are you available for work?*
What shift would you prefer?*
1st: 6am-2pm | 2nd: 2pm-10pm | 3rd: 10pm-6am
If needed are you available to work overtime?*
On what date can you start working if you are hired?*

MonthDayYear
Date
Do you have reliable transportation to and from work?*
Personal Information
YesNo
If yes, state name & relationship
YesNo
YesNo
What document can you provide as proof of citizenship or legal status?
Job Skills/Qualifications
Please list below the skills and qualifications you possess for the position for which you are applying
{Note: Harvest Valley Bakery complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions
Education and Training
High School
Name
Location City, State
Year Graduated
Degree Earned
College/University
Name
Location City, State
Year Graduated
Degree Earned
Vocational School/Specialized Training
Name
Location City, State
Year Graduated
Degree Earned
Previous Employment
Employer Name*
Job Title*
Supervisor Name*
Address*

Employer Address

Street Address Line 2

City, State and Zip CodeState / Province

Postal / Zip Code
Employer Telephone*
Format: (000) 000-0000.
Dates Employed*
Reason for leaving*
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City, State and Zip CodeState / Province

Postal / Zip Code
Employer Telephone
Format: (000) 000-0000.
Dates Employed
Reason for leaving
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City, State and Zip CodeState / Province

Postal / Zip Code
Employer Telephone
Format: (000) 000-0000.
Dates Employed
Reason for leaving
Military:
Are you a member of the Armed Services?*
What branch of the military did you enlist?
What was your military rank when discharged?
How many years did you serve in the military?
What military skills do you possess that would be an asset for this position?
Additional Information:
YesNo
If yes, please state the nature of the crime(s), when and where convicted and disposition of the case
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however,be considered.)
I hereby authorize and consent to Harvest Valley Bakery to perform a background check that includes, but is not limited to, my employment and education verification, social security verification, criminal and civil history, personal interviews, and other public records.
Applicant Signature*
Dated*

MonthDayYear
Date
Should be Empty:

Applicant Information

Employment Position

Personal Information

Job Skills/Qualifications

Education and Training

High School

College/University

Vocational School/Specialized Training

Previous Employment

Military:

Additional Information: