Employment Application Form - Baskin Robbins Page 2
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1
2Employment History
List below 3 employers starting with the most recent one
Name of Employer
Reason for leaving
Address
City
State
Zip
Starting Date
Leaving Date
Weekly Starting Salary
Weekly Ending Salary
May we contact your supervisor? Name of Supervisor
Title
Phone Number
Yes
No
Job title and description of duties/responsibilities
Name of Employer
Reason for leaving
Address
City
State
Zip
Starting Date
Leaving Date
Weekly Starting Salary
Weekly Ending Salary
May we contact your supervisor? Name of Supervisor
Title
Phone Number
No
Yes
Job title and description of duties/responsibilities
Name of Employer
Reason for leaving
Address
City
State
Zip
Starting Date
Leaving Date
Weekly Starting Salary
Weekly Ending Salary
May we contact your supervisor? Name of Supervisor
Title
Phone Number
Yes
No
Job title and description of duties/responsibilities
Certain diseases, including hepatitis A, salmonella, shigella, staphylococcus, streptococcus, giarda, E. coli and campylobacteria
may prevent you from serving food or handling food equipment in a sanitary or healthy fashion. An essential function of this
job involves handling and serving food, food service equipment and utensils in a sanitary and healthy fashion. Is there any
reason why you cannot perform the essential functions of this job?
No
Yes
If yes, explain.
1) I certify that I have read and fully completed both pages of this application and that the information contained on this
application is correct to the best of my knowledge.
2) If this application and interview leads to employment, I understand that any erroneous or misleading information in this
application or interview is grounds for dismissal.
3) I authorize the references listed in this application to provide any information concerning previous employment and
pertinent information they may have, personal or otherwise, and release all parties from all liabilities for any damages that may
result from furnishing this information.
4) You are applying for work with a franchisee of Baskin-Robbins, not Dunkin’ Brands, Inc. or any of its affiliates. If hired, the franchisee will
be your only employer. Franchisees are independent business owners who set their own wage and benefit programs that can vary among
franchisees.
Signature
Date
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Parent category: Business