Job Application

First Name*

MI

Last Name*

Preferred Name(Nickname)

Todays Date*

Date

Street Address*

City*

State*

Zip Code*

Date of Birth*

Date

Phone*

Email Address*

example@example.com

Are you authorized to work in the United States:*

YesNo

Are you interested in:*

Full TimePart TimeTemporary

What schedule are you interested in:*

WeekdayWeekendMorningAfternoon

What position are you applying for:*

CashierShift LeadManagerBaker

Desired Pay Range:*

When are you available to start:*

Have you worked here before:

YesNo

If Yes, when:

Do you know anyone that works here?

YesNo

If yes, Employee Name:

Legacy Bagels is an equal opportunity employer and does not discriminate against any applicant or employee because of race, color, religion, sex, national origin, disability, age, or military or veteran status in accordance with federal law. In addition, Legacy Bagels complies with applicable state and local laws governing non-discrimination in employment in every jurisdiction in which it maintains facilities. Legacy Bagels also provides reasonable accommodation to qualified individuals with disabilities in accordance with applicable laws.

I have submitted the attached form to the company for the purpose of obtaining employment. I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate the company to further process my application.

My signature below attests to the fact that the information that I have provided on my application, resume, given verbally, or provided in any other materials, is true and complete to the best of my knowledge and also constitutes authority to verify any and all information submitted on this application.

I understand that any misrepresentation or omission of any fact in my application, resume or any other materials, or during any interviews, can be justification for refusal of employment, or, if employed, termination from the Company's

SIGNED

DATE

Date

EMPLOYMENT APPLICATION

PLEASE PRINT OR TYPE

Please answer the following questions:

PLEASE READ CAREFULLY BEFORE SIGNING APPLICATION