PARLOR APPLICATION

Thank you for your interest in employment with Parlor Doughnuts in

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) Desired

Date Available

Date

(Last)

(First)

(Middle)

(Street)

(City)

(State)

Email Address

example@example.com

Salary 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 no, please explain

How did you learn about this position?

Please identify specifics

I am seeking (check all that are applicable):

I am willing to work (check all that are applicable): Days Evenings Rotating Shifts Weekends

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

Professional Data (if applicable)

Licensure, Certification, and/or Registration

Registration/ Certification/License Number

On a scale of 0 -5, with 0 indicating no experience and 5 indicating highly proficient, rate your expertise with the following:

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?

If yes, please list

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

Company

Job Title

(mo/vr)

(mo/yr)

Address

Street Address Line 2

City / State / Zip

Final Salary

Supervisor

Duties

Amount of notice given

Company

Job Title

(mo/yr)

Address

Street Address Line 2

City / State / Zip

Final Salary

Supervisor

Email

example@example.com

Duties

Reason for Leaving

Amount of notice given

Company

Job Title

(mo/ yr)

(mo/yr)

Address

Street Address Line 2

City / State / Zip

Final Salary

Supervisor

Email

example@example.com

Duties

Reason for Leaving

Amount of notice given

Company

Job Title

(mo yr)

(mo 'yr)

Address

Street Address Line 2

City / State / Zip

Final Salary

Supervisor

Email

example@example.com

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?

If yes, please explain

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.

Name

Company

Occupation/Relationship

Number of Years Known

Phone Number

Email

example@example.com

Name

Company

Occupation / Relationship

Number of Years Known

Phone Number

Email

example@example.com

Name

Company

Occupation / Relationship

Number of Years Known

Phone Number

Email

example@example.com

Applicant Certification and 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, and I understand that Company reserves the right to change wages, hours and working conditions as deemed necessary.

(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.

(initials) 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.

(initials) hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), and others about me as deemed appropriate by the Company, and hereby release the Company from any liability such contract.

(initials) I understand that any employment offer is contingent upon my providing, within three working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.

(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.

(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

Printed Name

Date