Applicant Information Last Name First Name M.I. Date Street Address Apartment/Unit #: City State Zip Phone Number Email Address Date Available Position Applied For Location You Are Applying To Total Hours Available/Week PROVIDE AVAILABILITY BELOW: Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday: Are there any days or hours you are unable or unwilling to work? If hired, are you able to show proof of authorization to work in the United States? YesNo Have you ever worked for this company? YesNo If so, when? Have you ever been convicted of a felony? YesNo If yes, explain: If hired, and you are UNDER the age of 18, can you furnish a work permit? YesNoI'm Over 18 Education Highschool: Address: Dates Attended From: To: Did you graduate? YesNo Degree: College: Address: Dates Attended From: To: Did you graduate? YesNo Degree: Other Education: Address: Dates Attended From: To: Did you graduate? YesNo Degree: References Full Name: Relationship: Company: Phone Number: Address: Full Name: Relationship: Company: Phone Number: Address: Previous Employment Company: Phone Number: Address: Supervisor: Job Title: Starting Salary/Wage: Ending Salary/Wage: Responsibilities: Ending Salary/Wage: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? YesNo Company: Phone Number: Address: Supervisor: Job Title: Starting Salary/Wage: Ending Salary/Wage: Responsibilities: Ending Salary/Wage: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? YesNo Company: Phone Number: Address: Supervisor: Job Title: Starting Salary/Wage: Ending Salary/Wage: Responsibilities: Ending Salary/Wage: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? YesNo Disclaimer and Signature I certify that the statements and information furnished by me in this application are true and correct and I understand that falsification of such statement and information is grounds for dismissal at any time the company becomes aware of the falsified information. In consideration of my employment, I agree to conform to the rules and regulations of your company and acknowledge that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the company of myself. I further understand that no policy, benefit or procedure contained in any employee handbook creates an employment contract for any period of time, and no terms or conditions of employment contrary to the foregoing should be relied upon, except for those made in writing by a designated officer of the Company. All the foregoing information is truthful and factual and it is my understanding that should falsification be discovered it will constitute grounds for dismissal. I agree and herby authorize Sequoia Sandwich Company to conduct a background inquiry to verify the information on this application and any company form completed by me. I authorize all previous employers or other persons who have knowledge of me or my records to release such information to Sequoia Sandwich Company. Signature: Date: