Belle Foods Employment Application .pdf

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Original filename: Belle_Foods_Employment_Application.pdf
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Employment Application

An Equal Opportunity Employer
TO APPLICANT:

Belle Foods, LLC is an Equal Opportunity Employer. We adhere to a policy of making all employment
decisions without regard to race, color, sex, religion, national origin, and age, and disability, status as
a disabled veteran or veteran from the Vietnam era, status, sexual orientation or citizenship.
A clear understanding of your back ground and work history will aid us in placing you in the position
that best meets your qualifications. Please complete and sign your application form. Failure to sign
the application will result in the application not being checked or considered further.
Applicant Information
Full Name:

Date:
Last

First

M.I.

Address:
Street Address

Apartment/Unit #

City

State

Phone:

ZIP Code

Email

Date Available:

Social Security No.:

Desired Hrly Rate$

Position Applied for: _______________________________________________________________________________________________
YES

NO

YES

If no, are you authorized to work in the U.S.?





Are you a citizen of the United States?

YES

NO

Have you ever worked for this company?

If yes, when?
YES

NO

YES

NO

Have you ever been convicted of a felony?
If yes, explain:
Have you ever been terminated from a previous
employer for cause?
If yes, explain:
FOR OFFICAL USE ONLY: To be completed by Store Manager
STORE # _______

Start Date: ________________

Status: Full Time

Part Time

Hourly Rate/Salary: ______________ Months of Experience: ________________

Hourly

Store Manager Signature: _______________________________________________

Salary

Date of Birth: ___________

1

Position: _____________________

NO

Education
High School:

Address:
YES

From:

To:

College:

Diploma:

Address:
YES

From:

To:

NO

Did you graduate?

Other:

Degree:

Address:
YES

From:

NO

Did you graduate?

To:

NO

Did you graduate?

Degree:

References
Please list three professional references.
Full Name:

Relationship:

Company:

Phone:

Address:
Full Name:

Relationship:

Company:

Phone:

Address:
Full Name:

Relationship:

Company:

Phone:

Address:

Previous Employment
Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:$

Ending Salary: $

Responsibilities:
From:

To:

Reason for Leaving:
YES

May we contact your previous supervisor for a reference?

2

NO

Previous Employment Continued
Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:$

Ending Salary:$

Responsibilities:
From:

To:

Reason for Leaving:
YES

NO

May we contact your previous supervisor for a reference?

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:$

Ending Salary: $

Responsibilities:
From:

To:

Reason for Leaving:
YES

NO

May we contact your previous supervisor for a reference?

Military Service
Branch:

From:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

3

To:

Disclaimer and Signature

I understand that this application is not intended to create, nor should it be construed to create, an express or
implied contract of employment. It does not create contractual obligations of any kind. If hired. I will be
employed at will; I understand that this means that either I am or the employer is free to terminate the
employment relationship at any time with or without notice
I certify that all of the information furnished on this application and during the application process is true,
complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts
called for may result in a refusal to hire or, if hired, may result in my dismissal at any time without any previous
notice. I authorize the investigation of all matters contained in this application and hereby give Belle Foods,
LLC permission to contact schools, previous employers, references and others. I hereby release Belle Foods,
LLC and those it contacts from any liability whatsoever as a result of such contact and the information provided
and received as a result of such contact. As a condition of my employment I hereby agree that if I am offered
employment, I will submit to a required medical evaluation and drug tests at the expense of Belle Foods, LLC.
I understand that any medical evaluation procedures are consistent with the Americans with Disabilities Act. I
further understand that the purpose of the examination is to determine whether I am able to perform the
essential functions of the position offered, with or without any reasonable accommodation. I understand that no
representative of Belle Foods, LLC, other than the General Manager, has any authority to enter into an
agreement for employment for any specified period of time. I understand that this application will remain active
for a period of thirty (30) days. After that time, if I desire further consideration, I must renew my application in
person.

SIGNATURE

DATE

4


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