CREPES'NCREPES

APPLICATION FOR EMPLOYMENT

It is our policy to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental handicap, or veteran status. Full Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Today's date:_ ___,.__ Street Address._ _ _ _ _ _ _ _ _ _ _ _ _ _ __ City _ _ _ _ _ _ _ _ _ _ _.State_ _ _ _ _ _ _ _ Zip _ _ _ _ _ _ __ __ Telephone _ _ _ _ _ _ _ _ _Social Security _ _ _ _ _ _ _DOB_ _ _ _ _.... Position applying for_ _ _ _ _ _ _ __ How did you hear of this o p e n i n g - - - - - - - - - - - - - - - - - - When can you start _ _ _ _ _ _ _ _ Desired W a g e - - - - - - - - - - Are you a U.S. citizen or otherwise authorized to work in the U.S. _ _ _ _ __ Do you have any outstanding warrants/ or are on probation _ _ _ _ _ if yes, please explain _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Have you ever been fired or laid off_ _ _ _ __, if yes, please explain _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Have you ever been convicted of a felony ___.Please explain_ _ _ _ _ _ _ _ _ __

Are you currently employed _ _ _ _Where _ _ _ _ _ _ _How long there _ _ __ Your reason for looking for another job_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Do you plan to keep that job if you are hired here _ _ If yes, what hours/days will you be available

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Are you in school_ _ Where_ _ _ _ _ _ _ Full time/part-time_ _ _ _ What is your availability_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

_Are you looking for full time employment_ _ __, if no, then how many shifts are you willing toworkperweek _________________________________________________________ Education: School name and location, year, major and degree

College_ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Other__________________________________ In addition to your work history, are there other skills, qualifications, or experience that we should know Employment history: start with your recent employer Company name_________________________________ Address____________________________________ Telephone_________________ Date Started___________ Date Ended _________Position_________________ Starting wage Reason for leavinD------------------------------------

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Name of supervisor________________________ May we contact-------------------

Company name_________________________________ Address____________________________________ Telephone_________________ Date Started__________ Date Ended _ _ _ _ _Position _________________ Starting Reason for leavine-___________________________________ wage Name of supervisor_____________________ May we contact.__________________ Attach additional information if necessary. I certify that the facts set forth set in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior employment history. I understand that employment at Crepes 'n Crepes begins with a three month probationary period, and during that time I can be terminated at any time, without prior notice. Signature--------------------------- Date-----------------------------