la Madeleine Country French Cafe
We are an equal opportunity employer
Name:
Phone Number:
Address:
City:
Position Desired:
State:
When would you be able to begin work?
(Proof of identity & eligibility will be required upon employment)
Are you legally eligible to be employed in the U.S.?
(If no, you may be required to provide authorization to work)
Are you over the age of 18 years?
Have you ever worked for any La Madeleine before?
Supervisor:
If yes, where?
Reason for Leaving:
When? (dates)
Do you have any relatives who work for the company?
If yes, who and where do they work?
Days and hours available: (If employed and my availability should change, I will notify my supervisor in writing)
MONDAY
TUESDAY
THURSDAY
WEDNESDAY
FRIDAY
SATURDAY
SUNDAY
FROM
TO
How did you hear about us:
Zip Recuiter
Social Media
Local Job Fair
Indeed.com
At Restaurant
TV or Print
APPLICANT INFORMATION
Company:
Phone:
Supervisor:
Location:
Reason for Leaving:
From:
To:
Pay Rate & Position:
May we contact your previous supervisor for a reference?
Company:
Phone:
Supervisor:
Location:
Reason for Leaving:
From:
To:
Pay Rate & Position:
May we contact your previous supervisor for a reference?
PREVIOUS EMPLOYMENT
Name and location of most recent school:
Degree/diploma or higest level of education:
EDUCATION
Have you ever been convicted of a crime?
If yes, please explain:
I understand I am applying for employment with a La Madeleine franchise, independent owner and operator. I certify that my answers are true and complete to the best of my knowledge, and I understand that any misrepresentation or omission of material fact will constitute grounds for immediate dismissal. I authorize companies, schools, and persons named above, and others, to furnish the above named employer with any information they may have regarding me. I agree that such companies, schools, persons, and others, shall not be liable in any respect if my employment is terminated because of misrepresentation or omission of material facts in this questionnaire. I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between the above named employer and me for either employment or for the providing of any benefit, and that my employers personnel policies and/or handbooks do not constitute an employment contract. I may be discharged at any time, with or without cause, and with or without notice, at any time, either at my option or at the option of my employer.
Signature:
Date:
DISCLOSURE AND RELEASE
Select state
Alabama
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California
Colorado
Connecticut
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Hawaii
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Maine
Maryland
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Michigan
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New Hampshire
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New York
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
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ANY
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ANY
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ANY
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11 AM
12 PM
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ANY
12 AM
1 AM
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6 AM
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8 AM
9 AM
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12 PM
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ANY
12 AM
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11 AM
12 PM
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ANY
12 AM
1 AM
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12 PM
1 PM
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ANY
12 AM
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11 PM
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12 AM
1 AM
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9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
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11 PM
ANY
12 AM
1 AM
2 AM
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4 AM
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6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
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10 PM
11 PM
ANY
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
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6 PM
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9 PM
10 PM
11 PM
Yes
No
Yes
No
Yes
No