Name

Address

City

State

Zip

Telephone Number

Email Address

Employment Position Employment Position BaristaPrep CookCashier

How did you hear about this position?

What days are you available to work?

What hours or shift would you be available to work?

What date are you available to start work, if hired?

Do you have reliable transportation to and from work? Do you have reliable transportation to and from work? Yes No

Are you 18 years of age or older? Are you 18 years of age or older? Yes No

Are you a U.S. Citizen or approved to work in the U.S.? Are you a U.S. Citizen or approved to work in the U.S.? Yes No

Do you have any condition which would require job accommodations? Do you have any condition which would require job accommodations? Yes No

If yes, please describe accommodations required.

Have you ever been convicted of a criminal offense (felony or misdemeanor)? Have you ever been convicted of a criminal offense (felony or misdemeanor)? Yes No

If yes, please state the nature of the crime(s).

Please list the skills and qualifications you possess for the position you are applying:

Do you have any experience in Marketing and/or Social Media for a previous employer? Do you have any experience in Marketing and/or Social Media for a previous employer? Yes No

If yes, please describe your experience/responsibilities:

Would you be interested in participating in the Marketing/Social Media effort for our brand? Would you be interested in participating in the Marketing/Social Media effort for our brand? Yes No

High School Name

Year graduated

College/University

Year graduated

Degree Earned

Previous Employer Name 1

Job Title

Supervisor’s Name

Employer Telephone

Dates Employed

Reason for leaving

Previous Employer Name 2

Job Title

Supervisor’s Name

Employer Telephone

Dates Employed

Reason for leaving

Please provide a name for a professional reference

Telephone Number of Professional Reference

Please provide a name for a personal reference

Telephone Number of Personal Reference