WORK IN A FUN, INVITING, AND DRIVEN ATMOSPHERE

Please complete the entire form. If you have any questions, please email info@bromemoderneatery.com.

Fields marked with an * are required.

Brome, Inc. is an Equal Opportunity Employer. Brome, Inc. (“Brome”) is committed to equal employment opportunity and prohibits discrimination based upon race, color, religion, sex, pregnancy, national origin, age, disability, marital status, height, weight, or any other status protected by applicable local, state and/or federal law.

Reasonable Accommodations for Disabilities Under Michigan Law. Applicants and employees have 182 days from the date they know or should know that an accommodation is needed to submit a written request for such an accommodation. If you need an accommodation, submit your written request to the Owner and President of Brome.

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INFORMATION
Last Name *
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First Name *your full name
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Middle Initial
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Date of Birth *
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Present Address *
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City *
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ZIP/Post Code *
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Phone *phone
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Previous Address
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City
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ZIP/Post Code
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Are you over 18 years of age?
Have you ever been convicted of a criminal offense other than a minor traffic violation?
If yes, indicate: date, place, nature of charge and disposition. (A conviction will not necessarily disqualify applicant from employment)
Please Indicate
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Are you legally authorized to accept employment in the United States?

Which location are you applying for?
Position you are applying for
Position you are applying for
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Salary Expected
$
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Per
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Availability
Days
Were you ever employed by Brome?
If yes, when?
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Have you applied for work at Brome during the last year?
If yes, when?
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EDUCATION
HIGH SCHOOL
High School *
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Address
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From
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To
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Did you graduate?
COLLEGE
College
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Address
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From
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To
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Degree
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OTHER
Other
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Address
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From
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To
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Degree
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List other special courses, training, or other skills which would assist you in performing the job applied for:
Listmore details
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REFERENCES
REFERENCE 1
Full Name *
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Relationship *
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Company*
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Phone*
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Address *
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REFERENCE 2
Full Name *
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Company*
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Relationship *
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Phone*
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Address *
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REFERENCE 3
Full Name *
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Company*
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Relationship *
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Phone*
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Address *
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U.S. MILITARY SERVICE
From
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To
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U.S. Branch Service
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Job Specialty
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Highest Rank Held
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Rank At Discharge
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EMPLOYMENT HISTORY
Please list all employment starting with present or most recent employer. Account for all time including secondary education, unemployment and service with U.S. Armed Forces. Use additional sheets if necessary. A less-than-honorable discharge from the U.S. Armed Forces is not an absolute bar to employment, depending on the nature of the job sought. A medical discharge from the U.S. Armed Forces will have no impact on your employment chances unless you are unable to perform the essential functions of the job for which you have applied with or without a reasonable accommodation.
COMPANY 1
Company
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Phone
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Address
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Supervisor
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Job Title
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Starting Salary
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Ending Salary
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Responsibilities
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From
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To
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Reason for leaving
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May we contact a supervisor for a reference?
COMPANY 2
Company
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Phone
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Address
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Supervisor
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Job Title
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Starting Salary
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Ending Salary
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Responsibilities
0 /
From
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To
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Reason for leaving
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May we contact a supervisor for a reference?
COMPANY 3
Company
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Phone
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Address
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Supervisor
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Job Title
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Ending Salary
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Starting Salary
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Responsibilities
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From
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To
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Reason for leaving
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May we contact a supervisor for a reference?

CAREFULLY READ THE PARAGRAPHS BELOW BEFORE SIGNING

I certify the answers and information given by me in this Application for Employment, in my resumé, and in any other materials I have submitted are true and complete. In the event of employment, I understand that if Brome, Inc. (“Brome”) at any time determines that any requested information was withheld or omitted by me or any of the answers or information provided by me are false, inaccurate or misleading, I will be subject to immediate dismissal once the facts become known.


I authorize Brome to contact all my former and current employers

(unless otherwise indicated by me in my Employment History on this Application)

, educational institutions, military entities, and the other references I have provided, regarding me and my performance record, and work, academic or military experience. I release Brome or any individual or company from any and all liability including liability for defamation (libel and slander) for releasing or using information concerning me and my performance record, and work, academic, or military experience.


I certify no promises of employment have been made to me and I understand no such promise is binding uponBrome. I acknowledge that any employment relationship with Brome is “at will,” which means I may resign atany time and Brome may discharge me at any time, with or without cause and with or without notice. I alsounderstand and agree that this "at will" employment relationship may not be modified or altered and that noemployee or representative of Brome, other than the Brome’s Owner & President (Sam Abbas), has authority to enter into any agreement for employment for any period of time or make any agreement contrary to theforegoing. To be effective, any such agreement must be in writing, signed by me and Brome’s Owner & President (Sam Abbas).


I understand that in the State of Michigan, disabled applicants and employees should notify Brome, in writing, of the need for accommodation within 182 days of the date the individual knows or should know that an accommodation is needed. I also understand that failure to properly notify Brome will preclude any claim under the Michigan Persons With Disabilities Civil Rights Act that Brome failed to accommodate the disability.


I agree that any action, lawsuit, claim or charge against Brome or it employees, agents or representatives, including but not limited to claims under federal and state civil rights statutes, arising out of the application process, my employment or termination of employment must be brought within one hundred eighty (180) days of the event giving rise to the action, lawsuit, claim or charge or be forever barred. I voluntarily waive any longer statute of limitations. If the applicable statute of limitations is less than 180 days, I agree the shorter statute of limitations period applies. I understand and agree than any action, lawsuit, claim or charge filed outside of this limitation period is forever barred and voluntarily waive any limitations period to the contrary.


Please read the all of the above carefully before signing. Your signature indicates that you expressly agree with all of the above.

Signature (type your full name) *
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Date *
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