COFFEE CAREERS

Name *

First Name

Last Name

Phone *

(###)

###

####

Cell Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Available Start Date *

Please designate your available start date.

MM

DD

YYYY

General Availability *

Please indicate all days you are available to work.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Type of Employment Desired *

Please list your desired employment type.

Full Time

Part Time

Temporary

Seasonal

If hired, can you provide documents required to establish your eligibility to work in the U.S.? *

Yes

No

Are you 18 years of age or older? *

Yes

No

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? *

Yes

No

Are you able to meet the attendance requirements of the position? *

Yes

No

Have you ever been convicted of, or pled guilty or no contest to, a crime other than a minor traffic violation? *

Yes

No

Education *

Please indicate the highest level of education you have completed.

GED or Equivalent

Senior High School (Graduate)

Some College (Former Student)

Active College Student

Associate's Degree

Bachelor's Degree

Master's Degree

Doctorate Degree

School Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is this your first job? *

Yes

No

May we contact this employer?

Yes

No

Employer Phone Number

(###)

###

####

Employer Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

May we contact this employer?

Yes

No

Employer Phone Number

(###)

###

####

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

May we contact this employer?

Yes

No

Employer Phone Number

(###)

###

####

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Reference Name

First Name

Last Name

Reference Phone Number

(###)

###

####

Reference Name

First Name

Last Name

Reference Phone Number

(###)

###

####

If your application receives favorable consideration, when will you be available to begin work? *

MM

DD

YYYY

Do you have any objection to working overtime? *

Yes

No

Can you work overtime without prior notice? *

Yes

No

Can you work on all holidays? *

Yes

No

Can you work on Saturday? *

Yes

No

Can you work on Sunday? *

Yes

No

Can you work standing on your feet for extended periods? *

Yes

No

Are you capable of lifting, stretching, pouring, or carrying for work "without any restrictions"? *

Yes

No

Signature of Applicant *

Please add your first and last name.

First Name

Last Name