Application for Employment

All portions of this application pertaining to you must be completed. We appreciate the time you will spend completing this
application. It is the policy and practice of this Company to provide all qualified employees and applicants for employment with equal
employment opportunities without regard to age, race, religion, color, sex, pregnancy, ancestry, national origin, disability or any other
status or condition protected by applicable law. We will provide, upon request, reasonable accommodations to assist applicants with
disabilities in applying for employment.

Position(s) applied for: ________________________________________________________________________________________

Salary expected: $ ________________ Per: _____________ Date of application: _________________

Name:

LAST FIRST MIDDLE
Address:

STREET CITY STATE ZIP CODE
Telephone #: Additional Phone #: Social Security #:
Have you submitted an application here before? Yes No
If yes, give date(s) ..
_________________
Have you been employed here before? .. Yes No
If yes, give dates From: _____________ To: _____________
Are you legally eligible for employment in this country? ... Yes No
Is your current age 16 years or older? . Yes No
Is your current age 18 years or older? ..... Yes No
If you are 16 or 17 years old, do you have your parents permission to work? . Yes No
Are you aware that you will need to obtain a work permit before starting work? . Yes No
How many sports do you play during the school year?
Are you available to work after school three out of five days each and every week? Yes No
Are you available to work on Saturday? . Yes No
Are you available to work on Sunday? . Yes No
Can you work shifts? . Yes No
If yes, what shifts can you work? First (early morning) Second (afternoon) Third (nights)
Date available for work _________________
Type of employment desired Full-Time Part-Time Temporary Seasonal
Will you work overtime if required? .. Yes No
If no, please explain. _____________________________________________________________________________________
Will you accept part-time employment? . Yes No

Deli Cafe Clerk (Full-time); Dishwasher (Full-time); Frozen Foods Clerk (Full-time); Produce Clerk (Full-time)
9.25 Hourly
martin lashell C
4359 Northfield Rd Apt 303 Warrensville Heights OH 44128
216-317-9334 279-86-0464

7/09/2014

07/14/2014
Employment Availability

Indicate days and hours available:
Monday from: ________________________________ to: _______________________________
Tuesday from: ________________________________ to: _______________________________
Wednesday from: ________________________________ to: _______________________________
Thursday from: ________________________________ to: _______________________________
Friday from: ________________________________ to: _______________________________
Saturday from: ________________________________ to: _______________________________
Sunday from: ________________________________ to: _______________________________


Education Background

Circle Highest Grade Completed:
Elementary 1 2 3 4 5 6 7 8 High School 9 10 11 12 GED College 1 2 3 4

Courses Now Studying: _______________________________________________________________________________________

TYPE OF SCHOOL
SCHOOL NAME
ADDRESS, CITY, STATE, ZIP CODE
TYPE OF DIPLOMA /
DEGREE
MAJ OR

HIGH SCHOOL




COLLEGE /
UNIVERSITY





GRADUATE /
PROFESSIONAL
NUMBER OF YEARS ATTENDED





TRADE /
VOCATIONAL /
OTHER
NUMBER OF YEARS ATTENDED




Military Information

Have you served in the U.S. Armed Forces? Yes No
Total months of Active Duty:

Branch of Service:

Rank of Induction:

Highest Rank Attained:

Specialized Military Experience:



Security Information

Have you been convicted of a felony or misdemeanor, other than a minor traffic offense, which has not been pardoned or expunged
from your record? Yes No

If yes list date, city, charge and disposition:




CONVICTION OF A FELONY OR MISDEMEANOR WILL NOT AUTOMATICALLY DISQUALIFY YOU FROM CONSIDERATION FOR EMPLOYMENT.



List any additional information you would like us to consider.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

8:00 4:00
8:00 4:00
8:00 4:00
8:00
4:00
8:00 4:00
8:00 4:00
8:00 4:00 AM
AM
AM
AM
AM
AM
AM
PM
PM
PM
PM
PM
PM
PM
G
N/A
Life Skills Center
4600 Carnegie Ave
Cleveland OH 44128
High School Diploma General Studies
Cleveland Institute of Dental/Medical Assistants
5564 Mayfield Rd
Lyndhurst OH 44124
Certificate Pharmaceutical Studies
X
X

I really wanna work for this company I often shop here at Zagara's the store seems very well organized and clean everyone is so nice it just seems like a
really nice atmosphere to work at.

Employment History

Please provide the following information for your past and current employers, assignments or volunteer activities, starting with the
most recent (use additional sheets if necessary). Explain any gaps in employment in comments section below.

EMPLOYER
DATES EMPLOYED

TELEPHONE
FROM TO
SUMMARIZE THE TYPE OF WORK
PERFORMED AND J OB RESPONSIBILITIES
ADDRESS


J OB TITLE
HOURLY RATE/SALARY

STARTING
IMMEDIATE SUPERVISOR AND TITLE

$ PER
REASON FOR LEAVING
HOURLY RATE/SALARY

FINAL
MAY WE CONTACT FOR REFERENCE?
YES NO LATER
$ PER

EMPLOYER
DATES EMPLOYED

TELEPHONE
FROM TO
SUMMARIZE THE TYPE OF WORK
PERFORMED AND J OB RESPONSIBILITIES
ADDRESS


J OB TITLE
HOURLY RATE/SALARY

STARTING
IMMEDIATE SUPERVISOR AND TITLE

$ PER
REASON FOR LEAVING
HOURLY RATE/SALARY

FINAL
MAY WE CONTACT FOR REFERENCE?
YES NO LATER
$ PER

EMPLOYER
DATES EMPLOYED

TELEPHONE
FROM TO
SUMMARIZE THE TYPE OF WORK
PERFORMED AND J OB RESPONSIBILITIES
ADDRESS


J OB TITLE
HOURLY RATE/SALARY

STARTING
IMMEDIATE SUPERVISOR AND TITLE

$ PER
REASON FOR LEAVING
HOURLY RATE/SALARY

FINAL
MAY WE CONTACT FOR REFERENCE?
YES NO LATER
$ PER

EMPLOYER
DATES EMPLOYED

TELEPHONE
FROM TO
SUMMARIZE THE TYPE OF WORK
PERFORMED AND J OB RESPONSIBILITIES
ADDRESS


J OB TITLE
HOURLY RATE/SALARY

STARTING
IMMEDIATE SUPERVISOR AND TITLE

$ PER
REASON FOR LEAVING
HOURLY RATE/SALARY

FINAL
MAY WE CONTACT FOR REFERENCE?
YES NO LATER
$ PER


Skills and Qualifications Summarize any special training, skills, licenses and/or certificates that may qualify you as being
able to perform job-related functions in the position for which you are applying.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

Comments Describe your greatest accomplishment from any previous position that you have held.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

Wendys 216-921-4242
4037 Mayfield Rd, South Euclid, OH
Cashier
Mike Norris
received another job
2/2003 12/2006
5.00
Cleaning, Stocking preparing food
5.15
Hour
Hour

Panera bread/ Caveli Enterprise 440-646-2233

Heinen's 216-921-6638
16611 Chagrin Blvd, Shaker Heights, OH
Produce Associate/Deli Associate
Eric
interested in a new job career
3/2013 7/2014
8.75
cut fruit and veggies for salad bar, slicing
and weighing meats at deli.
9.25
Hour
Hour

I have training using meat slicers cleaning the machine also weighing meats on them. I also have experience with cutting fruit and vegetables. Using
cash registers cleaning and stocking.
When I worked at Panera Bread I worked my way up to being a Certified Trainer for my great work ethic.

Referral Source

How did you find out about our employment opportunities?
Referred by Employee Employee Name:

Zagaras Website

Other Website Website Name:

Advertisement Source Name:

School / College School / College Name:

Walk-in / Drive By

Employment Agency Agency Name:

J ob Fairs Location of J ob Fair:

Other Source Name:



References

List name and telephone number of three business/work references who are not related to you and are not previous supervisors.
If not applicable, list three school or personal references who are not related to you.

NAME TELEPHONE


OCCUPATION
STREET ADDRESS CITY, STATE, ZIP CODE


YEARS KNOWN

NAME TELEPHONE


OCCUPATION
STREET ADDRESS CITY, STATE, ZIP CODE


YEARS KNOWN

NAME TELEPHONE


OCCUPATION
STREET ADDRESS CITY, STATE, ZIP CODE


YEARS KNOWN


READ BEFORE SIGNING
This application will become inactive after 6 months. If you wish to be considered for employment after that time, you must complete
a new application for employment. All applications will, however, be retained in our files for a period of 12 months.

*This company does not discriminate against qualified applicants or employees on the basis of race, creed, national origin, ancestry,
pregnancy, sex, color, age or other status or condition protected by applicable law. However, we insist that all of our employees can
perform the essential functions of their employment and have the character, integrity, and general reputation for honesty of a person
we would be willing to have to represent our Company in its dealings with customers, suppliers, and/or other employees. Accordingly,
we insist on complete honesty. ANY LATER DISCOVERY THAT AN APPLICANT WAS NOT HONEST IN COMPLETING THIS
APPLICATION MAY RESULT IN DISCHARGE.

AFFIDAVIT:
I authorize or instruct this Company to make whatever inquiries it deems necessary (of any employer, personal reference, or school
official named in this application or referred by a person named in this application and of any law enforcement agency) in order to
verify any information given in my application and/or determine my qualifications and abilities and I agree to release an hold harmless
all such persons from any and all liability arising from the release of such information. I understand that such inquiries may include
information as to my character, general reputation or personal characteristics. Statements I made in the application are true and
complete. I understand that if, in the judgment of the Company, I have made any false statements, omissions, concealments, any
misrepresentations or I have failed to answer any questions fully and accurately, or results of such investigation are not satisfactory,
any offer made by the Company may be withdrawn or my employment with the Company may be terminated immediately, without
any obligation to me other than for payment at the rate agreed upon for services rendered after I have been employed. I agree to
conform to the rules and regulations of the Company, and understand that, if I am hired, my employment and compensation can be
terminated, without cause or notice, at any time, at the option of either the Company or myself. I further understand that no personal
recruiter or interviewer or other representative of the Company has any authority to enter into any agreement for employment for any
specified period of time unless such agreement is in writing and signed by the Companys designated representative.


Signature of Applicant _________________________________________________________________ Date ________________
N/A
N/A
N/A

Kathy Lucas 440-231-0577