Name Date

Street City State Zip

Where can we call you? ( ) Email Address

How were you referred to us?

Name of source

Which position are you applying for?

o Baker o Baker’s Helper o Intern o Bread Baker o Bread Baker’s Helper

o Cake Decorator o Pastry Finisher o Driver/Helper o Pan Boy/Girl o Other: ...........................................

Y / N Are you eligible for employment in the United States? (Must provide proof of identity and eligibility upon employment)

Y / N Are you at least 16 years of age? (If not, you must provide a work permit.)

Y / N Has your drivers license been suspended or revoked?

Y / N Have you ever been convicted of a criminal offense? If yes, please provide details: (Feel free to use another sheet of paper if needed)

Date:_________________Place:______________________Nature:____________________________________ (An affirmative answer will not automatically disqualify you from being considered as a candidate for employment.)

Professional ReferencesName and Address Occupation Phone

1

2

3

Personal References (not relatives)Name and Address Occupation Phone

1

2

3

It takes a lot of terrific people to run a place like LaSalle Bakery! If you think you could be one of them, we’d like to hear from you. Please take a moment and submit an application to us. Thank You!

OccupationOccupationOccupationOccupationOccupationOccupationOccupationOccupationOccupationOccupationOccupationOccupation PhonePhonePhonePhone

993 Smith St. Providence, RI 02908 (401-831-9563) 685 Admiral St. Providence, RI 02908 (401-228-0081)

P

EducationSchool Name Address. City, State, Zip Degree/Major Completed?

High School Y / N

College Y / N

Grad School Y / N

Other Y / N

Additional Experience and Qualifications:Please list any other experience, skills or other qualifications including hobbies which should be considered in evaluating your qualifications for employment.

What Kind Of Work Would You Like To Do?o Full-Time o Part-Time o Temporary Until When? ___ /___ /___

Please indicate times your available in chart.

M T W TH F S SU

AM

PM

When are you available to begin working? ......................................................................................................................................................................................................................................................

Do you have pay requirements? ...........................................................................................................................................................................................................................................................................................

Do you have any commitments to another employer that might affect your employment with us? ..........................................................

............................................................................................................................................................................................................................................................................................................................................................................................................

Skill SheetPlease answer the following True or False questions:

Y / N I enjoy seeing the sunrise. Y / N I can work weekends.

Y / N I enjoy working in the evenings. Y / N I get along with co-workers.

Y / N I can work holidays. Y / N I can work many hours in December.

Y / N I love to eat great bread. Y / N I am always bright eyed and bushy tailed.

Y / N I am always in a good mood. Y / N I am a good cleaner.

Y / N I am very organized.

I Can Do the Following:Please check/mark the following that apply:

o Clean benches o Pay attention to details

o Problem solve o Work under stress and deadlines

o Be a quick learner o Multi task

o Work in warmer/hot work environment o Handle heavy lifting (up to 50 lbs..)

o Good people skills o Work in cooler/cold work environment

o Be on my feet for an 8-10 hour shift o Strong follow through skills

o Work with mixers/ovens o POS and/or PC skills

o Work with food o Work with digital scales

o Get along with everyone

What Is Your Favorite?Please circle your favorite LaSalle Bakery treat:

Please Answer the Following Questions1. Are you currently involved in any sports and/or extracurricular activities that would require accommodations from your

employment with us? If so, please list times and dates you are currently committed, or will be in the near future.

2. Lasalle Bakery is a high volume business with a work day that can be long and stress filled. What makes you believe you can work well and excel in these working conditions?

3. Have you ever been a guest in LaSalle Bakery, please describe what you enjoyed most about the experience?

4. What experience and knowledge do you expect to gain from working at LaSalle bakery?

5. When we check your references, what do you think they will name as your greatest strength? Greatest weakness?

6. As a staff member what do you expect from the managing partner, your managers and supervisor?

Agreement: Please Read Carefully and Sign.

I hereby affirm that the information provided on this application (and accompanying resume) is true to the best of my knowledge. I also understand that falsifying information or significant omissions may disqualify me from further consideration for employment and may considered justification for dismissal if discovered at a later date. I understand that my employment can be terminated, with or without cause, at any time at the discretion of either the company or myself. I understand that no management official other than the officers of LaSalle Bakery, has authority to enter into any agreement contrary to the forgoing or make any oral assurance or promise of continued employment. I authorize persons, schools, my current employer, and previous employers and organizations named in this application, to provide any relevant information that may be required to arrive at an employment decision. This includes LaSalle Bakery’s ability to obtain a report of my credit history, driving record, and other information that may be necessary in making an employment decision.

Signature: .............................................................................................................................................................................................. Date: ........................................................................

a report of my credit history, driving record, and other information that may be necessary in making an employment decision.

Signature: