I. Personal Information

  Name:      Last        First      Middle

  Present Address 

   Telephone 

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver’s license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

   Position Applied For:

  1.   Is there any information we would need about your name or use of another name for us to be able to check your work record?  Yes    No

      Please specify:

   2.   Do you have any relatives who are presently (or have formerly been) employed by Breakfast Woodworks?  Yes   No

   3.   How were you referred to Breakfast Woodworks ?

   4.   Have you ever been convicted of a felony?    Yes       No    If yes, please explain:

II. Educational History

                                              School Name / Location                        Years Completed                                   Degree/Diploma

  High School     

  College             

  Tech. Training 

  Other                

III. Employment Record  Please include all employment for the last five years.

    1. Company Name (Current or Most Recent Employer)       Position Held

       Address        Dates Employed:   From     To

         Manager / Supervisor        Telephone        Wage/Salary

         Reason For Leaving

    2.  Company Name (Current or Most Recent Employer)       Position Held

                                                                                     Address        Dates Employed:   From     To

         Manager / Supervisor        Telephone        Wage/Salary

         Reason For Leaving

   3.  Company Name (Current or Most Recent Employer)       Position Held

                                                                                     Address        Dates Employed:   From     To

         Manager / Supervisor        Telephone        Wage/Salary

         Reason For Leaving

  NOTE:  We will contact all of the employers listed on this application unless you specifically exclude them below. Please list any employers you do not want us to contact and your reason for the exclusion:

  (Employer’s Name)         Reason 

 (Employer’s Name)         Reason 

V. Work Availability

   1.     If your application receives favorable consideration, when will you be available to begin work? 

   2.     Do you have any objection to working overtime?   Yes    No

   3.     Can you work overtime without prior notice?         Yes    No 

   4.     Can you work on Saturday?     Yes       No 

   5.     Can you work on Sunday?        Yes       No 

   6.     Can you travel if required by this position?       Yes       No 

VI. Salary / Hourly Rate Requirements

If your application receives favorable consideration, what hourly rate would you require?

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