PARLOR DOUGHNUTS - TERRE HAUTE

APPLICATION FOR EMPLOYMENT
PARLOR DOUGHNUTS - TERRE HAUTE

Thank you for your interest in employment with Parlor Doughnuts in Terre Haute, 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 Desired*
Date Available*

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Minimum Hourly Salary Desired*
Are you 18 years old or older? (Individuals who are 14-17 years of age may be required to provide a work permit depending on state and county requirements.)*

YesNo
Do you have a driver's license?*

YesNo
Do you have reliable personal transportation? (You do not rely on an outside source for transportation)*

YesNo
Birthdate*

MonthDayYear
Date
Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment.*

YesNo
If no, please explain:
How did you learn about this position?*
If you were referred by a current or former employee, please list their name:

I am seeking to work: (Choose all that apply)*

Rows	Hours Available (3:00am-9pm)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Some weekend availability is required. Can you accommodate this requirement?*

YesNo
If you need to work around another schedule consistently or seasonally (e.g. school, extracurricular activities, participation in volunteer programs, etc), please provide any availability details that need to be coordinated/considered. We hire based on long-term availability, so seasonal activities should be mentioned here.*
Professional Licensure(s), Certification(s), and/or Registration(s)
Proficiency

On a Scale of 0-5 (with 0 indicating no experience and 5 indicating high proficiency), rate your proficiency in the following categories:
Operating a Point of Sale System*

0

1

2

3

4

5

0 is No Experience, 5 is High Proficiency
Operating Commercial Kitchen Equipment*

0

1

2

3

4

5

0 is No Experience, 5 is High Proficiency
Operating Coffee/Espresso Equipment*

0

1

2

3

4

5

0 is No Experience, 5 is High Proficiency
Organization and Tidiness*

0

1

2

3

4

5

0 is No Experience, 5 is High Proficiency
Quality Customer Service - Positive and Clear Communication*

0

1

2

3

4

5

0 is No Experience, 5 is High Proficiency
Do you speak a second Language? If so, please list.
Please list any other skills or qualifications that may be relevant to working at Parlor Doughnuts Terre Haute. (Exclude those which indicate race, color, sex, religion, disability, age, national origin, or any other protected category.)
Work History

Beginning with your current/most recent employment, please complete the section below in full. Incomplete information could disqualify you from further consideration.
Job 1

CompanyPosition
Dates Employed

From (month/year)To (month/year)
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Salary

StartingEnding
Supervisor
Duties
Reason for Leaving
Job 2

CompanyPosition
Dates Employed

From (month/year)To (month/year)
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Salary

StartingEnding
Supervisor
Duties
Reason for Leaving
Amount of Notice Given for Leaving
Amount of Notice Given for Leaving
Job 3

CompanyPosition
Dates Employed

From (month/year)To (month/year)
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Salary

StartingEnding
Supervisor
Duties
Reason for Leaving
Amount of Notice Given for Leaving
Job 4

CompanyPosition
Dates Employed

From (month/year)To (month/year)
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Salary

StartingEnding
Supervisor
Duties
Reason for Leaving
Amount of Notice Given for Leaving
Have you ever been discharged from a position or asked to resign from a position in lieu of being discharged?*
If yes, please explain.
Personal 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.)
Name*

First NameLast Name
Company/Organization*
Occupation/Relationship*

RelationshipNumber of Years Known
Contact Info.*

Phone NumberEmail Address
Name*

First NameLast Name
Company/Organization*
Occupation/Relationship*

RelationshipNumber of Years Known
Contact Info.*

Phone NumberEmail Address
Name*

First NameLast Name
Company/Organization*
Occupation/Relationship*

RelationshipNumber of Years Known
Contact Info.*

Phone NumberEmail Address
Applicant Certification and Agreement

In exchange for the consideration of my job application with the Company, I agree that:
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.*
Type Initials Here
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.*
Type Initials Here
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.*
Type Initials Here
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*
Type Initials Here
Signature*
Printed Name*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

APPLICATION FOR EMPLOYMENT

PARLOR DOUGHNUTS - TERRE HAUTE

Proficiency

Work History

Personal References

Applicant Certification and Agreement