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As an equal opportunity employer, La Bamba Ice Cream and Snacks does not discriminate in hiring because of an individual’s race, color, religion, gender, gender identity, or expression, national origin, citizenship, age, disability, sexual orientation, martial or veteran status. La Bamba Ice Cream and Snacks only hires individuals authorized for employment in the United States.

Full Name

Date

Present Address

City

State

Zip

Permanent Address

City

State

Zip

Phone Number

Secondary Phone Number

Referred By

Position of Employment Desired

Date You Can Start

Salary Desired

Are You Employed Now?

If So, May We Inquire of Your Present Employer?

Are You Legally Authorized to Work In The U.S.?

Ever Applied to This Company Before?

If So, Where?

When?

Education History - High School

Years Attended

Did You Graduate

Subjects Studied

College

Years Attended

Did You Graduate

Subjects Studied

Trade, Business, or Correspondence School

Years Attended

Did You Graduate

Subjects Studied

Subject of Special Study/Research Work

Special Training

Special Skills

U.S. Military or Naval Service

Rank

Former Employer #1 - Name and Address

Date Started

Date Ended

Salary

Position

Reason for Leaving

Former Employer #2 - Name and Address

Date Started

Date Ended

Salary

Position

Reason for Leaving

Reference #1 - Name

Address

Business

Years Known

Reference #2 - Name

Address

Business

Years Known

Authorization

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”

Electronic Signature

Date