Barry Bagels - Career Opportunities

First Name

Middle Name

Last Name

Address 1

Address 2

City

State

Zip

Daytime Phone

Alt. Phone

Email

Are You a U. S. Citizen?

Yes No

Convicted of a felony in last 7 years?

Yes No

If Yes, Briefly Explain

Position interested in

Top two store locations you would like to apply to:

If employed and under 18, can you furnish a work permit?(Optional)

Yes No

If Yes, enter your age?

Have you filed an application with this company before?

Yes No

Were you previously employed with us?

Yes No

Do you have any friends or relatives who work with us?

Yes No

If yes, list their names?

On what date would you be available to work?

Are you able to work FullTime?

Yes No

Are you employed now?

Yes No

If so, may we contact your present employer?

Yes No

Do you have a car available for use?

Yes No

Are you prevented from lawfully being employed in this country because of Visa or Immigrant status?

Yes No

Are you a veteran of the U.S. Military Service?

Yes No

If so, which branch?

Name

Home Phone

Work Phone

Elementary

4 5 6 7 8

High School

9 10 11 12

College

1 2 3 4

Graduate School

1 2 3 4

Diploma / Degree?

Yes No

Employer Name, Phone Number, and a brief summary of your duties

Employed From

Employed Till

Employer Name, Phone Number, and a brief summary of your duties

Employed From

Employed Till

Additional Skills/Experience

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
5AM-10AM
10AM-1PM
1PM-4PM
4PM-8PM
10PM-6AM

Career Opportunities

Please indicate the times you are available to work:

In case of emergency, who should we contact?

Education (Optional)

Employment/Skills Summary