Masada Bakery, llc

1500 Oakbrook Drive Norcross, GA 30093

404-377-4555 678-682-6698 fax
Employment Application
Applications are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or in the presence of a non-related medical condition or handicap.
Name_______________________________________________________Date___________________
Address___________________________________________________Phone #___________________
City_____________________State_____Zip__________Social Security #_______________________
Date of Birth_________________ Are you a citizen of the United States of America? [ ] Yes [ ] No
Have you applied here before? [ ] Yes [ ] No When?______Position applied for?_________________
Start When_______________ [ ] Full time [ ] Part time [ ] Temporary [ ] Other__________________
EMERGENCY CONTACT: Name_____________________Phone Number______________________________
EMPLOYMENT EXPERIENCE; Start with your present job. Include military assignments and volunteer work.
Employer 1__________________________________________________________________________
Address___________________________________City________________State_____Zip__________
Phone #________________Supervisors’ Name_____________________________________________
Job Title______________________Reason for leaving_______________________________________
Dates of Employment: From_________To__________Salary or Hourly rate______________________

Employer 2__________________________________________________________________________

Employer 3__________________________________________________________________________

EMPLOYMENT APPLICATION PART 2

EDUCATION

Schools/Collages Attended: # Years Year Grad. Degree

Have you been convicted of a felony in the past seven (7) years? [ ] Yes [ ] No

If yes, provide details including date, location (city), nature of offense and disposition:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
NOTE: A conviction record will not necessarily be a bar to employment. This information will only be used for job-related purposes consistent with applicable law. Failure to answer this question honestly will result in discontinued consideration of your application or termination of your employment.

Driver’s License #_______________________________State__________Expiration_______________

I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination.

For Personnel Department only

Remarks____________________________________________________________________________