Independent Energy Inc

DUDLEY’S FAMOUS BAKERY & DELI, LLC SAN DIEGO COUNTY, CALIFORNIA

APPLICATION FOR EMPLOYMENT Please fill in giving complete answers to all items which apply.

It is the policy of this company to give equal opportunity to all qualified applicants. All employment practices provide that individuals be recruited, hired, assigned, advanced, compensated and retained on the basis of their qualifications and treated equally without regard to race, color, creed, national origin, age or gender.

PERSONAL: DATE: ______

Name______Social Security #______Last First Middle Initial

Present Address ______No. Street City State Zip Telephone No.

How did you learn of this opening? ______

Have you worked for us before? ______If so, when? ______EDUCATIONAL BACKGROUND:

Name and Address # of Years Completed Courses or Major Diploma or Degree

High School ______

College ______

Post Graduate ______

Business/Trade ______

Other ______

MILITARY SERVICE RECORD

Have you ever served in the armed forces? ______If yes, what branch?______

Dates of Duty: From ______To ______Rank at Discharge ______

Current Reserve Obligation? ______

Nature of Duties: ______

Duties that would apply to a position at Dudley’s: ______EMPLOYMENT HISTORY: Please list most current first and then back in order

Address (City, Street, State) Start Date Month, Year Base Pay

Employer______Name and Title of Supervisor End Date Month, Year Base Pay

Your position and duties Reason for leaving ______

Your position and duties Reason for leaving

May we contact the employers listed above?______If not, indicate below which ones you do not wish us to contact:

What special skills do you have? ______

Please list any other experiences or qualifications which you feel would benefit our company should you be hired:

PLEASE READ CAREFULLY

I understand that Dudley’s Famous Bakery & Deli, LLC is a drug free environment and random drug testing may occur to ensure compliance, any refusal to cooperate shall result in immediate termination of employment. I additionally understand all persons are hired on a 90 day probationary period and may be terminated during this period with or without reason, at the company’s sole discretion. I hereby certify that the answers given and statements made are true and correct. I hereby authorize all my previous employers or references to furnish any information concerning my educational or employment records. You may make investigation through credit and other investigating agencies. I hereby release all such persons from liability or damages incurred as a result of inquiry and furnishing this information.

______Witness (company interviewer) Applicant’s signature

Dudley’s Famous Bakery & Deli, LLC San Diego County, CA