Work With Us

Name of Employer

Full Address/Phone Number of Employer

Supervisor’s Name/Title

Position(s) Held

Describe the Work Performed Dates Employed/Reason for Leaving: Starting Salary Ending Salary May we contact this organization for a reference?

Yes

If no, why not?

III. Education

Please identify the education or training which you believe qualifies you for the position you are seeking. (Please read the position description before providing this information.)

High School or GED

City/State Diploma or GED Received?

Yes

If no, what is the highest grade completed? College Name

City/State Degree?

Yes

Major(s): Any related training?

Where taken? Certification?

Yes

Topics Studied: Please review the position description before answering this question. List any other knowledge, skills, or traits not previously mentioned that would help you to perform the essential functions of this position:

IV. References

If you have not provided at least two employer references in Section II, please provide two references (other than relatives) that you have known for at least three years. Do not repeat your employer references here. You may include others with whom you have worked.

Please provide the requested information below:

Name

Occupation

Relationship to You

How long have you known this person? Email Address: Phone Number(s):

Please provide the requested information below:

Name

Occupation

Relationship to You

How long have you known this person? Email Address: Phone Number(s):

I understand that, by accepting this application, Mama Bev’s Bakery, LLC is in no way obligated to provide me with employment, and that I am not obligated to accept employment if offered. Furthermore, if employed, I understand that I am employed at-will, which means that Mama Bev’s Bakery, LLC and/or I can end the employment relationship at any time with or without notice or cause, consistent with applicable law.

I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that any falsified statement or important omission of fact on either this application or during the pre-employment process will result in my application being rejected or, if I am hired, in my employment being terminated.

I also understand that any offer of employment is conditioned upon the verification of my information. I authorize Mama Bev’s Bakery, LLC to verify any and all information provided on this application and/or during the pre-employment process and I will, upon request, sign other necessary consent forms. I hereby release Mama Bev’s Bakery, LLC, and those who provide information about me, from any/all liability of whatever kind and nature which, at any time, could result from obtaining, and/or having an employment decision based on, such information.

Applicant’s Signature: Date:

I. Personal Information

II. Work Record

III. Education

IV. References