Last Name / First Name / Middle
Street Address / City / State / Zip Code
Home Phone: ( ) / Cell Phone: ( ) / Email
Have you ever applied at Berkeley Bowl Produce before? ☐Yes ☐ No
Do you have any relatives employed at Berkeley Bowl? ☐Yes ☐ No
If yes, please provide their names and relationship to you:
If you are not a U.S. citizen, do you have the legal right to work in the United States? ☐Yes ☐ No
(Proof of right to work in the U.S. will be required upon employment.)
Have you ever been terminated or asked to resign from any job?☐Yes ☐ No
If Yes, please explain the circumstances.
If hired, can you furnish proof that you are over 18 years of age?☐Yes ☐ No
Are you capable of satisfactorily performing the essential job duties required of the position for which you are applying with or without accommodation?:☐Yes ☐ No
Position
Position Applied for: / Date Available:
Type of Employment
☐Full-time ☐Part-time ☐Temporary / Hours Available
How were you referred to Berkeley Bowl Produce Inc.?
☐Advertisement (Identify):
☐Agency / ☐Employee referral (Name):
☐Other (Please Specify):
Education
Education / Name & Location / Graduate?Yes/No / Major/Minor / Degree
High School / Yes/No
University / Yes/No
Graduate School / Yes/No
Other / Yes/No
Do you have any plans to continue your education? If yes, please describe:
Please list areas of expertise or skills related to this position (professional training):
WORK HISTORY (List your most recent employer first):
Employer: / Type of Business:
Month/Year Started: / Month/Year Ended: / Address: / Title:
Supervisor’s Name: / Reason for Leaving:
Phone: ( )
Responsibilities:
May we contact this employer? ☐Yes ☐ No
Employer: / Type of Business:
Month/Year Started: / Month/Year Ended: / Address: / Title:
Supervisor’s Name: / Reason for Leaving:
Phone: ( )
Responsibilities:
May we contact this employer? ☐Yes ☐ No
Employer: / Type of Business:
Month/Year Started: / Month/Year Ended: / Address: / Title:
Supervisor’s Name: / Reason for Leaving:
Phone: ( )
Responsibilities:
May we contact this employer? ☐Yes ☐ No
REFERENCES: List 3 People (Not relatives) who can tell us about your professional qualifications.
Name: / Company Name: / Title
Telephone: ( ) / Working Relationship:
Name: / Company Name: / Title
Telephone: ( ) / Working Relationship:
Name: / Company Name: / Title
Telephone: ( ) / Working Relationship:
I certify that all statements given by me on this application and in accompanying documentation, are true and correct without omission. I understand that any misstatement I have made with relation to my employment application may result in dismissal. I further authorize Berkeley Bowl Marketplace to investigate my past record at any time and agree that neither Berkeley Bowl Produce Inc., previous employers, schools etc., shall be held liable in any respect in an employment offer in not tendered, withdrawn, or my employment is terminated due to falsity of statements and answers in the application form or accompanying documentation. If I am employed, I understand that additional personal data will be required for determination of benefit eligibility and for statistical purposes. If employed by the Berkeley Bowl Produce Inc., I agree to abide by its rules and regulations.
I understand that neither this application nor any communication by a management representative is intended to create or does create a contract of employment, offer, or promise of employment.
Berkeley Bowl Produce Inc. is an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability, or any other consideration made unlawful by applicable federal, state, or local laws.
I agree to complete any requisite authorization forms for the background investigation, to be performed by Talentwise.
______(This application is not a contract and is not intended to create a contract.)
SignatureDate
Pg. 2 of 2, Rev.Dec 2017 MIS