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La Sure's Cafe & Bakery • Phone: 920.231.5227 • 1570 Ripon Lane || La Sure's Banquet Hall • Phone: 920.651.0796 • 3125 S Washburn St.

Employment Application

Please fill out form completely for employment consideration. For a printable version of this form, click here.

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin or handicap. We are an equal opportunity employer. View our Privacy Policy.
Position Applying For:
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Availability
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When will you be able to work?
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Personal Information

First Name
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Last Name:
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Home Phone:
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Business Phone:
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Email Address:
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Street Address:
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City/State:
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Zip Code:
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How long have you lived here?
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Previous Address: (include Street Address, City, State, and Zip)
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Are you at least 18 years old?
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If not, employment is subject to verification of minimum legal age.
Have you ever applied for employment with us?
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If yes, Month and Year:
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Location:
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How did you learn of our organization?
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Are you legally authorized to work in the US?
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Social Security Number:
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Driver's License #:
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State Issued:
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Any violations?
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Have you been convicted of a crime in the past ten y ears, excluding misdemeanors and summary offenses, which has not been annulled, expunged, or sealed by a court?
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If yes, explain 1) nature of charges, 2) date issued, and 3) county and state where issued.
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Are there any reasons for which you might not be able to perform the job duties (with a reasonable accommodation)?
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If yes, please explain:
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Education

High School Name and Location (city & state):
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Number of Years Completed:
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Major Subjects:
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Did you graduate?
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Degree/Diploma Received:
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Did you attend a trade school?
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Trade School Name and Location (city & state):
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Number of Years Completed:
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Major Subjects:
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Did you graduate?
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Degree/Diploma Received:
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Did you attend college?
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College Name and Location (city & state):
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Number of Years Completed:
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Major Subjects:
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Did you graduate?
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Degree/Diploma Received:
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Did you attend another school?
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School Name and Location (city & state):
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Number of Years Completed:
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Major Subjects:
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Did you graduate?
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Degree/Diploma Received:
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Military

Have you ever served in the U.S. Armed Forces?
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Branch of Service:
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Period of Active Duty (Month & Year)
From:

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To:

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Date of Final Discharge:

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Rank at Discharge:
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Describe your duties and any special training:
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Employment History

Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer.
Are you currently employed?
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If yes, may we contact your current employer?
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Company Name:
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Company Address:
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Company Phone:
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Name of Immediate Supervisor:
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Employed From:

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To:

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Hourly Rate Start:
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Ending Rate:
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Job Title and Description of Your Work:
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Reason for leaving:
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Any additional employment?
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Company Name:
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Company Address:
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Company Phone:
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Name of Immediate Supervisor:
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Employed From:

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To:

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Hourly Rate Start:
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Ending Rate:
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Job Title and Description of Your Work:
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Reason for leaving:
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Any additional employment?
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Company Name:
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Company Address:
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Company Phone:
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Name of Immediate Supervisor:
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Employed From:

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To:

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Hourly Rate Start:
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Ending Rate:
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Job Title and Description of Your Work:
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Reason for leaving:
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Any additional employment?
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Company Name:
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Company Address:
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Company Phone:
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Name of Immediate Supervisor:
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Employed From:

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To:

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Hourly Rate Start:
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Ending Rate:
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Job Title and Description of Your Work:
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Reason for leaving:
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We may contact the employers listed above unless you indicate those you do not want us to contact.
Do Not Contact:
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Reason:
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References

Give below the names of three persons not related to you, whom you have known at least one year.

Reference #1

Name:
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Address:
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Business:
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Years Acquainted:
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Reference #2

Name:
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Address:
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Business:
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Years Acquainted:
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Reference #3

Name:
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Address:
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Business:
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Years Acquainted:
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Terms and Conditions

The information provided in this Application for Employment is true, correct and complete. If employed, any misstatements or omissions of fact on this application may result in my dismissal.

I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

If you decide to engage an investigative consumer reporting agency to report on my credit and personal history, I authorize you to do so.

If a report is obtained you must provide, at my request, the name and address of the agency so I may obtain from them the nature and substance of the information contained in the report.

Electronic Signature:(*)
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Please enter your full first and last name.

(*)
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