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Please provide ALL information on this form. Incomplete applications will not be considered.

All persons shall have equal employment opportunities regardless of age, ethnicity, gender, religion, marital status, veteran status, national origin, and physical or mental disability; employment shall be based solely on the Company's needs and the individual's qualifications.

Applicant Information

First Name

Middle Initial

Last Name

Address

City

State

Zip

Position Applying For

(Area Code) Telephone Number

Are you at least 18 years of age?
Yes No

Most Recent Employer

Company Name

Company Address

City

State

Zip

(Area Code) Company Phone Number

Supervisor's Name

Supervisor's Title

Date Hired

Date Last Worked

Pay Rate

Per Hour

Per Week

Per Year

Commission/Bonus

Job Title

Job Duties

Reason for Leaving

May we contact this employer?
Yes No

Most Recent Employer

Company Name

Company Address

City

State

Zip

(Area Code) Company Phone Number

Supervisor's Name

Supervisor's Title

Date Hired

Date Last Worked

Pay Rate

Per Hour

Per Week

Per Year

Commission/Bonus

Job Title

Job Duties

Reason for Leaving

May we contact this employer?
Yes No

Most Recent Employer

Company Name

Company Address

City

State

Zip

(Area Code) Company Phone Number

Supervisor's Name

Supervisor's Title

Date Hired

Date Last Worked

Pay Rate

Per Hour

Per Week

Per Year

Commission/Bonus

Job Title

Job Duties

Reason for Leaving

May we contact this employer?
Yes No

Education & Training

High School (City, State)

Level Attained

Year 1

Year 2

Year 3

Year 4

Diploma

GED

Major Course of Study (if applicable)

College (City, State)

Level Attained

Year 1

Year 2

Year 3

Year 4 or higher

Diploma

Major Course of Study

Graduate or Other Education

Level Attained

Major Course of Study (if applicable)

Other Job Related Skills and Training

Availability

Please check all that you are available to work

Evenings

Early Mornings

Variable Hours

Overtime

Saturday

Sunday

Holidays

Full Time

Regular Part Time

Temporary Full Time

Are you on layoff and subject to recall in your current job?
Yes No

If yes, Expected Recall Date

If offered a position, when would you be available to start work?

Background

How were you referred to us?

Employment Agency

Newspaper

Employee

Walk-in

Other

Have you applied for employment with this company before?
Yes No

If yes, When/Where

Have you ever worked in a bakery before?
Yes No

If yes, When/Where

Do you have a relative currently employed here?
Yes No

If yes, Name (Relationship)

Were you in the Armed Forces?

Dates

Branch of Service

Reserve Status

Have you been convicted of any law violation other than traffic violations within the past 5 years?
Yes No

If yes, When/Where

Explanation

Are you legally able to work in this country?
Yes No

NOTE: If hired, you will be required to show identity and work eligibility documents.

Are you willing to undergo a physical and/or drug testing, and criminal background check?
Yes No

Driving Record

NOTE: Complete this section only if the position for which you are applying would require you to drive a company vehicle (for example, Fleet, Route Sales, Transportation).

Driver's License No.

State Issued

Has your driver's license ever been suspended?
Yes No

If yes, Why/When

Approximate number of auto accidents in the last 5 years

Describe

Release

By submitting this form, I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions of any kind whatsoever. I agree that the company shall not be liable in any respect if my employment is terminated because of the falsity of statements, answers or omissions made by me in this questionnaire. I agree to submit to a physical examination and drug testing. I also authorize the companies, schools or persons named above to give any information regarding my employment, together with any information they may have regarding me whether or not it is in their records. I hereby release the aforementioned persons, corporations, agencies, associations and their employees, agents and representatives from any and all liability for damages resulting from a decision by the Klosterman Baking Company Inc. not to employ me on the basis of compliance or any attempts at compliance with this authorization except for any damages resulting from knowingly providing false or misleading information or records about me.

Employment at Klosterman Baking Company Inc. is terminable at will unless such employment is governed or affected by an express contract duly signed by an authorized officer of Klosterman Baking Company Inc. Associate manuals or handbooks, or policy statements by Klosterman Baking Company Inc., that affect employment are subject to change at any time and shall not be treated as contractual documents.

Klosterman Baking Company Inc. complies with the requirements of the Immigration and Reform Control Act of 1986.

A copy of this authorization shall be effective and valid as the original, and shall be valid for 12 months from the date it is submitted.

Klosterman Baking Co.
4760 Paddock Road
Cincinnati, OH 45229
(513) 242-1004
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