Candy Tyme

Application for Employment

All portions of this application pertaining to you must be completed.

The company, in accordance with State and Federal laws, does not discriminate on the basis

of age, race, religion, color, sex, national origin, marital status, or physical/mental handicap.

PLEASE PRINT

Name __________________________________________________________

Address ________________________________________________________

City/State/Zip___________________________Telephone _________________

Are you a US citizen? _______ If not, a Permanent Resident Alien? _________

Are you 18 years or older? _________

How were you referred to Candy Tyme? _______________________________

Have you ever applied to Candy Tyme? _________

If yes, where and when? ____________________________________________

Position for which you are applying ________________Salary desired _________

Other positions for which you are applying _______________________________

Work hours for which you are available:

Monday: __________ Tuesday: __________ Wednesday: __________

Thursday: __________ Friday: __________ Saturday: __________

Sunday: __________

If your application is considered favorably, what date can you start work? _______

EDUCATION

School name City Yrs Att. Degree

High School ________________________________________________

College ________________________________________________

Graduate ________________________________________________

Other ________________________________________________

SPECIAL AWARDS AND/OR ACHIEVEMENTS

_________________________________________________________________

EMPLOYMENT RECORD

(Please list most recent position first)

Employer ________________________________ Dates __/__/__ to __/__/__

Job Title _________________________________ Salary ________________

Address _________________________________ Phone ________________

Supervisor _______________________________May we contact? ________

Reason for leaving _______________________________________________

Employer ________________________________ Dates __/__/__ to __/__/__

Job Title _________________________________ Salary ________________

Address _________________________________ Phone ________________

Supervisor _______________________________May we contact? ________

Reason for leaving _______________________________________________

PERSONAL REFERENCES

Name 2 people you have known for at least three years.

Name _________________________ Name _________________________

Address _______________________ Address ________________________

City/State/Zip __________________ City/State/Zip ___________________

Phone # _______________________ Phone # ________________________

Occupation _____________________ Occupation _____________________

How long have you known? ________ How long have you known? ________

READ THIS PARAGRAPH

I certify that the information contained in this application is correct to the best of my knowledge, and I understand that falsification of this application in any detail is grounds for disqualification from further consideration or for dismissal from employment. I understand that if employed, my employment is "at will", that is, that my employment and compensation can be terminated, with or without cause, and with or without further notice, at any time, at the option of either the company or myself. I further understand that no personnel recruiter or interviewer or other representative of the company has the authority to enter into any agreement for employment. Any representation, verbal or written, contrary to the company's "at will" policy is null, void, and without legal effect. I hereby authorize Candy Tyme to make any investigation and inquiry into any history represented on this application. I hereby authorize any and all employers, schools, corporations or persons, to release such information as requested by Candy Tyme, whether such response be verbal or written.

Applicant's Signature: ______________________________ Date ___/___/___