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GOLDEN BEAR BIKES
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Job Application

An Equal Opportunity Employer
Company is an equal opportunity employer. This application will not be used for limiting or
excluding any applicant from consideration for employment on a basis prohibited by local,
state, or federal law. Applicants requiring reasonable accommodation in the application and/
or interview process should notify a representative of the organization.
Please print and fill out all sections

Applicant Information

General Information

Application Name:*
First and Last Name
Daytime Phone:*
Email Address:*
Are you over the age of 18?*
YesNo
Birth Date:*
Applicants under 18 must provide verification minimum legal working age.

Address:

Street:*
City:*
State & Zip:*

Employment Position:

Position(s) applying for:*
Temporary work - such as summer or holiday work?*
YesNo
Full time position?*
YesNo
Days Available:*
MTWTRFSSun
How many hours per week would you like to work?*
When are you available?*
Salary Desired?*

Background Information

Are you a US citizen?*
Must provide acceptable forms of ID when hired.
YesNo
Have you ever been convicted of a criminal offence (felony or misdemeanor)?*
YesNo
If yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the case.
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)
Have you worked in a retail store?*
YesNo
If yes, please explain
Have you been employed in a bicycle shop?*
YesNo
If yes, please explain:
Have you been employed as a mechanic?*
YesNo
If yes, please explain:
Additional Information Relating to Bicycles: (i.e Raced for x team for y years, member of a bicycling club, etc...)*
Why are you interested in working in the bicycle industry?*
What if any previous knowledge of bicycling do you have?*

Employment History

Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment. If you have attached a resume, this section may be omitted

Are you currently employed?*
YesNo
Name of Employer:
Name of Supervisor:
Telephone Number:
Business Type:
Business' Address:
City, State, Zip:
Length of Employement: (Include Dates)
Position held:
Duties & Responsibilities
Please list them, separated by a comma.
Reason for leaving?
May we contact your employer?
YesNo
Name of Employer:
Name of Supervisor:
Telephone Number:
Business Type:
Address:
City, State, Zip:
Length of Employement: (Include Dates)
Position held:
Duties & Responsibilities:
Please list, separating items with a comma.
Reason for leaving?
May we contact your employer?
YesNo
Name of Employer:
Name of Supervisor:
Telephone Number:
Business' Address:
Address:
City, State, Zip:
Length of Employement: (Include Dates)
Position held:
Duties & Responsibilities:
Reason for leaving?
May we contact your employer?
YesNo

References

List below three persons who have knowledge of your work performance within the last four years. We prefer professional references.

Name:
First & Last
Telephone Number:
Occupation:
Number of years acquainted:
Name:
First & Last
Telephone Number:
Occupation:
Number of years acquainted:
Name:
First & Last
Telephone Number:
Occupation:
Number of years acquainted:

Please Read and Initial Each Paragraph, then Sign Below

I*
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.
II*
I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.
III*
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
Is all the information you submitted correct to the best of your knowledge?*
YesNo
Applicant's Signature:*
type in your name.
Date:*

Note: * indicates required information.