Mrs. Fields' Original Cookies, Inc.

Application For Employment

Le’s Family LLC. DBA Mrs. Fields' Original Cookies, Inc.(MFOC) is an equal opportunity employer dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, sex, religion, national origin, disability, or any other prohibited basis of discrimination as provided under applicable state & federal law.

All employees of Le’s Family LLC are “at will” employees subject to termination at any time with or without cause.

Le’s Family LLC. MFOC provides reasonable accommodations for the known disabilities of applicants, unless to do so would pose an undue hardship to the company. Please feel free to let us know if you need an accommodation to complete the application process.

Personal Information

_____-_____-_____ _______________ _______________

Social Security No. Day Phone Evening Phone

_______________________ ______________________ ______________________

Last Name First Name Middle Name

______________________ ______________________ ______________________

Street Address City/State Zip

Are you at least 18 years of age? Yes No

Per the company’s nepotism policy, list name/location of relatives employed by Mrs. Fields Cookies, Original Cookie Company, Hot Sam Pretzels, Pretzel Time, Pretzelmaker, Great American Cookies or TCBY.

Name _________________________ Location _________________________

Name _________________________ Location _________________________

Employment Desired

Position Desired				Available
Do you have a reliable method of transportation?			o yes o no o most of the time o not sure
Have you ever applied or worked for Mrs. Fields' Cookies, Original Cookie Company, Hot Sam Pretzels, Pretzel Time, Pretzelmaker, Great American Cookies, or TCBY? o yes o no
When	Where
Are you currently employed?		What is your salary requirement?

Please indicate the number of hours you would prefer to work each week.											___________ Hours
In each box indicate one of the following					“A” - Available to Work; Leave Blank - Not Available to Work
	Day									Night
Monday	9	10	11	12		1	2	3	4	5		6	7	8	9
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Due to the nature of the industry we cannot guarantee days or the number of hours.
Education

	Name	Address	Major	Graduated
High School
College				Yes o No o
University				Yes o No o
Trade School				Yes o No o
Other				Yes o No o

Employment History

(beginning with the most recent employer and explain gaps)

1.	^Dates	^Name, Address, Phone	^Final Rate of pay
	^Position	^Reason For Leaving
	^Job Duties
2.	^Date	^Name, Address, Phone	^Final Rate of Pay
	^Position	^Reason For Leaving
	^Job Duties
3	^Date	^Name, Address, Phone	^Final Rate of Pay
	^Position	^Reason For Leaving
	^Job Duties

Excluding organizations in which name or character indicates background, race, creed, age, sex, color, national origin, or disability, list areas of special interest (i.e. civic, athletic, fun, etc.)

Which best describes Your Personality?
Very Outgoing q		Usually Outgoing q			Sometimes Outgoing q			Shy q
Which best describes your sales ability?
Excellent q		Good q		Average q			No Experience q
Have you ever been fired from a job?
	No q		Yes q			Almost q
Reason

Have you ever been convicted of a crime? Yes q No q (Conviction will not necessarily disqualify an applicant from employment. The recency, severity, & pertinence of the conviction to the job will all be considered.) NOTE: Leaving this question blank will be considered a “NO” answer. List the crimes you have been convicted of below. Please provide details.

Can you perform, with or without reasonable accommodations, the essential job functions of the position for which you have applied?

References

List the names of three people not related to you who have known you at least one year. (Preferably your last three supervisors or those who know you other than as a friend/personal)

Name

Address

Phone

Years Known

Referral Source

To assist us in determining the most effective recruiting method, please mark the following source(s) you used to hear about the position you are applying for:

In-Store Application Card	Placement Svs (please list type)
Personal Referral	Business Card
Newspaper Ad	Other
Job Fair

Applicant’s Certification & Agreement

In consideration of being employed by Le’s Family LLC. DBA Mrs. Fields' Original Cookies, Inc. I understand & agree that:

1. This application is not a contract of employment.

2. Any doctor, hospital or testing laboratory has my consent to conduct medical or drug tests on me, & I hereby give my consent to release all information for the employer to determine my abilities to perform job duties now or in the future. I also give my consent to physical searches of myself, lunch box, locker, purse, or any packages I have while on the company’s premises, whether or not I have a lock on such items.

3. The needs of the employer may require overtime to be scheduled. I accept these conditions of employment.

4. Mrs. Fields' Original Cookies, Inc. is an equal opportunity employer. The employer does not discriminate in employment & no question on the employment application is used for the purpose of limiting or excluding any applicant’s consideration for employment on any basis prohibited by local, state or federal law.

5. If employed, I may terminate my employment at any time without notice or cause, & the employer may terminate or modify the employment relationship at any time without prior notice or cause. In consideration of my employment, I agree to conform to the rules & regulations of the employer, & I understand that no department head or representative of the employer, other than the president or vice president of the employer, has any authority to enter into any agreement, oral or written, for employment for any specified period of time or to make any agreement or assurances contrary to this policy.

6. If employed, I understand & agree that my employment is for no definite period of time, & may, regardless of the date of payment of wages & salary, be terminated at any time without any previous notice. If terminated, the employer is liable only for wages or salary earned as of the date of termination.

7. This application is current & active for only thirty (30) days. At the conclusion of this time, if I have not had any contact from the employer & still wish to be considered for employment, it will be necessary for me to reapply.

8. I have read & agree to the above & hereby certify that the facts I have provided in my employment application are true & complete. If I misrepresent or deliberately leave out a fact in my application, I may be refused employment, or if employed I may be terminated.

Signature

Date

Revised 4/24/00