We are an Equal Opportunity Employer. All applicants are considered without regard to race, color, religion, disability, sex, national origin, age, or any other basis protected by federal, state, or local law. This employment application is only active for 90 days. After this time a separate employment application must be submitted in order to be considered for employment.
Personal Information
First Name:
Middle Name:
Last Name:
Street Address:
City:
State:
Zipcode
Phone:
Email:
How did you find out about this job?
Newspaper
Referral
Who?
Other
How?
If hired, do you have a reliable means of transportation to get to work?
YES - NO
What is it?
Minimum salary expected:
Are you at least 18 years old?
YES - NO
If the job you are applying for requires driving:
Driver's License #:
State issued:
Expiration date:
Are you legally eligible for employment in the U.S.? (Proof of U.S. citizenship or immigration status will be required if hired.)
YES - NO
Have you been convicted of a crime?
YES - NO
If yes, state the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.)
Employment Data
Are you seeking:
Temp./Intern
Full-time
Part-time
What Scholars location are you seeking employment?
Indianapolis
Gourmet Cafe & Wine Bar
Bakehouse
Bloomington
Gourmet Cafe & Wine Bar
Bakehouse (College Ave.)
Bakehouse (E 3rd St.)
Wholesale
What position(s) are you applying for?
What hours and shift(s) would you prefer to work?
What hours and shift(s) would you prefer not to work?
Please indiacte any shift(s) you would NOT be available to work:
Are you willing to work:
Overtime?
Weekends?
Holidays?
Are you currently employed?
YES - NO
If hired, when would you be able to start?
Have you ever worked for this organization before?
YES - NO
If yes, name used:
List any friends or relatives employed by this company:
Are you on layoff and subject to recall?
YES - NO
Have you ever been discharged or asked to resign from any position?
YES - NO
If yes, please explain:
How many days have you missed from school or work in the last year other than approved vacation, sick, or disability leave?
Are you able to perform the job tasks of the role you are applying for with or without reasonable accommodation?
YES - NO
Please describe which tasks, if any, you will need accommodation to perform, and explain what type of accommodation you will need:
Education
(check highest level attained)
Secondary:
9
10
11
12
G.E.D.
Name of School:
Location of School:
College:
1
2
3
4
5
6
7
8
Name of School:
Location of School:
Degree & Major:
Minor:
Other education notes:
Military Service
Are you a veteran?
YES - NO
If yes, give dates of service:
From:
To:
List any special skills or training:
Work History
(Please list your last four employers. Begin with the most recent.)
Company 1
Company Name:
Phone No. w/ Area Code:
Street Address:
City:
State:
Zipcode:
Dates of Employment:
From:
To:
Salary:
Beginning:
Ending:
Job Title:
Supervisor's Name:
Supervisor's Title:
Describe duties briefly:
Specific reason for leaving:
Company 2
Company Name:
Phone No. w/ Area Code:
Street Address:
City:
State:
Zipcode:
Dates of Employment:
From:
To:
Salary:
Beginning:
Ending:
Job Title:
Supervisor's Name:
Supervisor's Title:
Describe duties briefly:
Specific reason for leaving:
Company 3
Company Name:
Phone No. w/ Area Code:
Street Address:
City:
State:
Zipcode:
Dates of Employment:
From:
To:
Salary:
Beginning:
Ending:
Job Title:
Supervisor's Name:
Supervisor's Title:
Describe duties briefly:
Specific reason for leaving:
Company 4
Company Name:
Phone No. w/ Area Code:
Street Address:
City:
State:
Zipcode:
Dates of Employment:
From:
To:
Salary:
Beginning:
Ending:
Job Title:
Supervisor's Name:
Supervisor's Title:
Describe duties briefly:
Specific reason for leaving:
May we contact all of the employers listed above?
YES - NO
If not, tell us which one(s) you do not wish us to contact and why:
How many jobs have you had in the last five years that are not listed above?
Why are you seeking a new position at this time?
List any business-related outside interests and organizations you're active in:
Approval
Please read the following carefully,
then check the "I Approve" checkbox below.
"I Approve"
(I have read, understand, and agree to the above.)
Check over the application to make sure it is complete and approved.