Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date Available for Work *

MM

DD

YYYY

Are you 18 years of age or older? *

Yes

No

Do you have any friends or family working for Bread of Life Center? *

Yes

No

I understand the organization has, or may choose to implement, a program of appropriate Company-paid pre-employment physical examinations, including standardized drug screens. Offers of employment may be subject to the successful completion of such an examination, as well as verification of previous employment, education, and references. Any disparity between results of these efforts and the information contained in the application form may result in the withdrawal of such employment offer, or if work has begun, the termination of my employment. *

Check yes as your consent

Yes

No

I authorize the Organization and its representatives to contact personal references, past supervisors, educational institutions and credit reporting agencies, as it may deem necessary to obtain satisfactory information. I also authorize those contacted to release this information. *

Yes

No

I certify that all of the information on this application was provided by me and is true. If employed, I agree to comply with all rules, regulations, and policies of the organization. I understand and agree that my employment relationship with the Organization is on an “at will” basis, meaning that either the organization or I may terminate my employment at any time, for any lawful reason, with or without cause and with or without notice. I further understand and agree that if at any time during my employment any of the information herein is found to be misleading or untrue, my employment may be terminated. *

Yes

No

I understand that, if employed, I will be required to furnish verification of my legal right to work in the Unites States by providing acceptable documentation as required by statute within 72 hours of commencement of employment. Further, I understand that in accordance with current Department of Homeland Security legislation, my employment will be terminated at the end of that period should I not furnish the required documentation. *

Yes

No