Apply for Employment

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Our hours are 6:30am-1pm. What days are you available to work? *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Have you ever applied to / worked for Daily Bread before? *

Yes

No

If hired, would you have reliable transportation to/from work? *

Yes

No

Are you over the age of 18?

(If under 18, hire is subject to verification of minimum legal age.)

Yes

No

If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? *

Yes

No

Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation? *

Yes

No

Have you ever been convicted of a criminal offense (felony or misdemeanor)? *

Yes

No

Please read the below paragraphs and virtually sign this form by selecting "I agree to the above statements". *

I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company. This application is not an express or implied employment contract. Virginia is an “employment at will” state and employees of Daily Bread do not have a contract of employment. Because employment with the company is based upon mutual consent, the right of the employee or the employer to terminate the employment relationship at any time is recognized and affirmed. I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.

I agree to the above statements

Today's Date *

MM

DD

YYYY