EMPLOYMENT APPLICATION BoDeans Baking Holding Company is an Equal Opportunity Employer and as such considers all qualified applicants for employment, regardless of race, color, sex, national origin, ancestry, religion, marital or veteran status, age or disability.	DATE OF APPLICATION
NAME (LAST, FIRST, MIDDLE INITIAL)	TELEPHONE NO.
PRESENT ADDRESS CITY STATE	HOW LONG AT THIS ADDRESS
PREVIOUS ADDRESS CITY STATE	YEARS AT THIS ADDRESS
E-MAIL ADDRESS	BEST TIME TO BE CONTACTED	ARE YOU 18 YEARS OR OLDER?
How were you referred to BoDeans? Walk-In Newspaper Ad Radio Ad Website Job Service Employee Referral Other Are you allowed to be lawfully employed in this country? Yes No If hired, you will be required to submit documents sufficient to establish employment authorization and identity, in compliance with the Immigration Reform Control Act of 1986. Do you have any relatives or friends who work for BoDeans? Yes No If yes, what are their names and relationships? What caused you to apply for employment with BoDeans? Have you applied at BoDeans before? Yes No Have you ever worked at BoDeans before? Yes No If yes, when? If yes, when? Employment Desired Position Applying for Date Available Employment Type: On-Call Temporary Full-Time Part-Time Shift Desired: 1st 2nd 3rd Expected Starting Salary Willing to Work Overtime: Yes No Military Service Have you ever served in the U.S. Armed Services? Yes No Dates of Service: Branch: Rank: Duties performed and training received:
No Yes Have you ever been convicted of, or plead guilty to or nolo contendere to or no contest to, a felony or misdemeanor, including DUI's and DWI's? This would not include minor traffic violations or a case that has been expunged, sealed, dismissed, erased, pardoned, or impounded. If yes, explain below. NOTE: Answering yes will not necessarily disqualify an applicant from employment. Factors such as age and date of the offense, the seriousness of the violation and rehabilitation will be considered. Failure to disclose all criminal convictions and/or to disclose fully any other requested information may disqualify you from further employment consideration, may result in the revocation of an existing offer of employment, and/or may result in the termination of your employment with BoDeans. If you answered “yes,” please explain, including the date(s) and nature of each offense. Please be accurate and complete. No Yes Have you ever been disciplined or discharged for sexual harassment, fighting, assault, or related offenses? If yes explain. No Yes Have you ever been disciplined or discharged for violating safety rules? If yes explain. EDUCATIONAL BACKGROUND
HIGH SCHOOL	LEVEL COMPLETED 9 10 11 12	DEGREE EARNED	MAJOR / COURSE OF STUDY
COLLEGE	LEVEL COMPLETED 1 2 3 4	DEGREE EARNED	MAJOR / COURSE OF STUDY
TRADE/BUSINESS/CORRESPONDENCE SCHOOL	LEVEL COMPLETED 1 2 3 4	DEGREE EARNED	MAJOR / COURSE OF STUDY
OTHER
WHAT OTHER SPECIAL SKILLS OR QUALIFICATIONS DO YOU HAVE?

EMPLOYMENT HISTORY: List your last three employers, starting with MOST CURRENT Are you currently employed? Yes No Ok to contact current employer? Yes No
EMPLOYER NAME	EMPLOYMENT DATES From: To:
ADDRESS	STARTING HOURLY RATE / SALARY	FINAL HOURLY RATE / SALARY
POSITION (S) HELD & JOB DUTIES	SUPERVISOR
REASON FOR LEAVING ELIGIBLE FOR REHIRE? Yes No	PHONE #
EMPLOYER NAME	EMPLOYMENT DATES From: To:
ADDRESS	STARTING HOURLY RATE / SALARY	FINAL HOURLY RATE / SALARY
POSITION (S) HELD & JOB DUTIES	SUPERVISOR
REASON FOR LEAVING ELIGIBLE FOR REHIRE? Yes No	PHONE #
EMPLOYER NAME	EMPLOYMENT DATES From: To:
ADDRESS	STARTING HOURLY RATE / SALARY	FINAL HOURLY RATE / SALARY
POSITION (S) HELD & JOB DUTIES	SUPERVISOR
REASON FOR LEAVING ELIGIBLE FOR REHIRE? Yes No	PHONE #
EMPLOYER NAME	EMPLOYMENT DATES From: To:
ADDRESS	STARTING HOURLY RATE / SALARY	FINAL HOURLY RATE / SALARY
POSITION (S) HELD & JOB DUTIES	SUPERVISOR
REASON FOR LEAVING ELIGIBLE FOR REHIRE? Yes No	PHONE #
REFERENCES: Names of three professional references (co-workers, banker, clergymen, etc.) NOT related to you whom you have worked with on more than a friendship level and have known at least three years.
NAME:	YEARS KNOWN:	HOW KNOWN:	PHONE:
NAME:	YEARS KNOWN:	HOW KNOWN:	PHONE:
NAME:	YEARS KNOWN:	HOW KNOWN:	PHONE:

Applicant Certification, Authorization and Agreement:

(Please read carefully before signing)

I hereby certify that all the information provided by me on my Employment Application and in support of my Employment Application is true and complete to the best of my knowledge. I also understand that any misrepresentation or omission of facts on the Employment application is reason for not hiring me or cause for my dismissal, if I am hired.

I hereby authorize BoDeans Baking Holding Company, in connection with my employment, to investigate and inquire into my personal history, financial history, medical history and all other matters relative to arriving at an employment decision; and as a result of this investigation, I agree to hold blameless and free of all liability, BoDeans Baking Holding Company and all other persons, firms, corporations, schools, hospitals, former employers, and government agencies that provide information from their knowledge or records in direct response to inquiries made by BoDeans Baking Holding Company.

I hereby authorize BoDeans Baking Holding Company to provide any and all information concerning my employment to any person or firm with whom I later seek employment and, I agree to hold BoDeans Baking Holding Company blameless and free of all liability as a result of furnishing such information.

Furthermore, if hired by BoDeans Baking Holding Company, I understand and agree that:

My employment is for no definite period and may be terminated at any time without prior notice.

I will comply with all company rules, regulations and policies, written or oral.

If requested, I will submit to a physical examination and will do so when requested.

All records pertaining to my employment are and will remain property of BoDeans Baking Holding Company.

Signature	Date

Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap. As an employer/government contractor, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Applicant Data Record. We appreciate your cooperation. Refusal to provide this information will not subject you to adverse treatment. This data is for periodic government reporting and will be kept in a Confidential File separate from Application for Employment.

Name _____ ______________________________________________ Date _____ ______________________________________________________

Position Applied For _____________________________________________

Government agencies require periodic reports on sex, ethnicity, disability, and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information about a disability is voluntary.

Check one:	Male _____	Female _____

Check one of the following:

Race/Ethnic Group:

_____ American Indian or Alaskan Native – A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment.

_____ Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

_____ Black or African American – A person having origins in any of the Black racial groups of Africa.

_____ Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

_____ White – A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

_____ Hispanic or Latino(a) (all races) – A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of culture.

_____ Hispanic or Latino(a) (White race only) – A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, and of the White race.

_____ Hispanic or Latino(a) (all other races) – A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, and of any race other than White.

Check if any of the following are applicable:

Vietnam Era Veteran _____	Disabled Veteran _____	Disabled Individual _____