Employment Application Form

First Name:
Middle Initial:
Last Name:
Present Address(Street):
Address(City):
Address(State):
Zip Code:
Home Phone:
Mobile Phone:
Primary Email:
Secondary Email:
Are you a citizen of the U.S. or do you have a legal right to work in the U.S.?
Yes No
Position Applying For:	Baker Bakery/café associate Assistant Manager
Preferred Bakery Cafe Location:	View Map of our Locations

What type of position are you looking for?	Full-time Part-time Summer Temporary
In the past 5 years have you been convicted of a felony relating to theft or dishonesty?
No Yes
If Yes, When?
Where?
Nature and disposition of conviction:
Have you previously applied for employment with Saint Louis Bread Company or Panera Bread?
No Yes
If Yes, When?
Where?
Were you interviewed?	No Yes
If Yes, Indicate by whom (If you remember)?
Are you related to associate employed by Saint Louis Bread Company or Panera Bread?
No Yes
If Yes, indicate name, relationship, and location:
Salary Expected (Minimum):
Date available for employment:
*Are you 18 years of age or older?	No Yes
*If under 18 years of age, applicant will be required to submit a birth certificate or work certificate as required by state and federal law.
This is when I am available to work:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
This is what my dream schedule would be:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Total hours per week available:
Educational Data:
Name and address of High School attended:
Have you graduated?	No Yes
Name and address of College (Other) attended:
Have you graduated?	No Yes
Date of degree conferred (MM/YY):
Major:
Minor:
Name and address of Graduate School attended:
Have you graduated?	No Yes
Date of degree conferred (MM/YY):
Major:
Minor:
Are you presently enrolled in school?	No Yes
If Yes, give name and address of school:
Are you enrolled day or night?	Day Evening
List States and Countries of residence for the past seven years:
Please list any other job related accomplishments, professional distinctions, certifications, or verifiable volunteer work that Panera should know about:
Office Skills: (If applicable to the position for which you are applying):
Typing or keyboarding speed:	WPM
Shorthand or Notetaking Speed	WPM
Describe the office equipment and computer software you can operate:
Military History :
Military Service Status	Veteran Non-Veteran National Guard Reserves Advanced ROTC
Branch of Service:
Dates of Service:
From (MM/YY):	To (MM/YY):
Did you receive any military training related to the job for which you are applying for?
Yes No
If Yes, Please Explain:
References:
Reference 1:
Name and Occupation:
Address:
Phone:
Reference 2:
Name and Occupation:
Address:
Phone:
EMPLOYMENT HISTORY(list all present and past employment beginning with the most recent)
1: Company name and address:
Immediate Supervisor:
Job title:
Phone:
Dates of employment:
From (MM/YY):
To (MM/YY):
Starting Wage or Salary:
Present/Final Wage or Salary:
Reason for leaving(if applicable):
Describe your duties:
May we contact this employer?	Yes No
2: Company name and address:
Immediate Supervisor:
Job title:
Phone:
Dates of employment:
From (MM/YY):
To (MM/YY):
Starting Wage or Salary:
Present/Final Wage or Salary:
Reason for leaving(if applicable):
Describe your duties:
May we contact this employer?	Yes No
1: Company name and address:
Immediate Supervisor:
Job title:
Phone:
Dates of employment:
From (MM/YY):
To (MM/YY):
Starting Wage or Salary:
Present/Final Wage or Salary:
Reason for leaving(if applicable):
Describe your duties:
May we contact this employer?	Yes No
DECLARATION(Carefully read each section and initial then sign at bottom.)
I certify that the answers given herein are true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, with the exception of contacting my present employer if I have requested so.
I have read, understand, and agree to the above statement.
Please initial here:
While this application will be retained on file for a period of one year (as required by law), I acknowledge that this application will be considered active for a period of sixty (60) days. At that time, I must submit a new application to be considered for any employment openings.
I have read, understand, and agree to the above statement.
Please initial here:
I understand and acknowledge that unless otherwise defined by applicable law or written agreement with Panera Bread, any employment relationship with the Company is considered "employment at will", which means the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by any conduct unless such a change is specifically executed by the President/Vice President of Panera Bread.
I have read, understand, and agree to the above statement.
Please initial here:
If I should be employed by the Company, I understand that any false, incomplete, or misleading information given on this application or during an interview shall result in immediate discharge.
I have read, understand, and agree to the above statement.
Please initial here:
I authorize an inquiry into my background by all persons, schools, companies, corporations, credit bureaus, law enforcement agencies, doctors, and other consulting consumer reporting agencies to supply information concerning my previous employment, education, credit, driving record, etc.
I have read, understand, and agree to the above statement.
Please initial here:
I authorize the references listed above to give representatives of Panera Bread any and all information concerning my previous and current employment and any pertinent information they may have, personal or otherwise, and release all parties from any and all liability from any damage that may result.
I have read, understand, and agree to the above statement.
Please initial here:
Signature:
Date (MM/DD/YY):

Panera Bread is an Equal Opportunity Employer.

Panera Bread does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a asis prohibited by local, state or federal law.