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APPLICATION FOR
EMPLOYMENT
PANERA
BREAD
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Panera Bread of Minnesota and western Wisconsin is an equal opportunity
employer that does not discriminate on the basis of race, religion,
color, sex, national origin, age, citizenship, ancestry, familial
status, veteran status, disability, sexual orientation, alienage,
marital status or any other characteristic prohibited by Federal,
State, or local law. |
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PERSONAL INFORMATION
Today’s Date
Email
Address
Name
Last
First
Middle
Present Address
Street
City
State
Zip Code
Permanent Address
Street
City
State
Zip Code
Phone Number(s)
Home
Work
Cell or Pager
Are you 18 or Older?
Are you legally eligible for employment in the U.S.?
Are You Employed Now?
If so, may we inquire of your present employer?
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POSITION DESIRED
Referred By:
Employee (Please State Name/Location:
)
Newspaper
Internet Agency
School/College
Career Fair
Other
AVAILABILITY
FULL-TIME
PART-TIME DATE YOU COULD START:
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And Hours Available |
Mon.
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Tues.
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Wed.
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Thurs.
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Fri.
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Sat.
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Sun.
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From
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To
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Have you ever worked for this Company before?
If yes, where: Which
Franchise?
City/State
Supervisor’s Name
Do you have any relatives, including spouse, already
employed by this Company?
If yes, please state name and location:
Other information you would like us to consider regarding
your employment or availability:
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WORK EXPERIENCE Please
list your current or most recent three jobs.
MILITARY SERVICE
EDUCATION
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Name & Location of School |
Last Year Completed |
Did you Graduate? |
Subject Studied and Degree(s)
Received |
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High School
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College
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Trade or Business School
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Subjects if Special Study or Research Work:
Activities Other Than Religious (Hobbies, Civic, Athletic, etc.)
:
EXCLUDE ORGANIZATIONS, THE NAME, OR CHARACTER OF WHICH INDICATES THE
RACE, CREED, COLOR, OR NATIONAL ORIGIN OF ITS MEMBERS
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SECURITY DATA
Have you been convicted of a crime within the last
five years?
If yes, please briefly describe the circumstances of
your conviction, indicating the date, nature, place of the offense,
disposition of the case and in what court. A conviction may bar you
from employment under the laws and regulations set in force by the Division
of Alcoholic Beverage Control in the state of Minnesota or Wisconsin.
This will be looked upon as one of the factors considered in the employment
decision and is evaluated in terms of the nature, severity, and date
of the offense.
AS
A CONDITION OF MY APPLICATION AND/OR EMPLOYMENT, I AUTHORIZE INVESTIGATION
OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION
OR OMISSION OF FACTS CALLED FOR IS JUST CAUSE FOR DISMISSAL. IF HIRED
I AGREE TO FOLLOW THE RULES AND REGULATIONS OF HEALTH AND LEGAL AUTHORITIES
AND SUCH RULES AND REGULATIONS THAT PANERA BREAD OF MINNESOTA AND WESTERN
WISCONSIN OR ANY OF ITS LICENSEES MAY FROM TIME TO TIME PRESCRIBE. INCLUDING,
IF NOT PROHIBITED BY LAW, LIE DETECTOR TEST, MY REFUSAL TO COOPERATE
WILL BE JUST CAUSE FOR DISMISSAL.
SIGNATURE __________________________________________________
DATE______________
Revised 6/21/05
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