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Name
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First
Last
Date of Birth
*
Social Security Number
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Email Address
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Phone Number
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Desired Hourly Wage
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Position Applied for:
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Barista
Customer Service Associate
Cook
Gender
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Male
Female
Other
Are you authorized to work in the U.S.?
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Yes
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If yes, please select your status
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U.S. Citizen
Permanent Resident (Green Card)
EAD Card
Your Mailing Address
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City
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Zip Code
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Have you been convicted of a felony?
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No
If yes, please explain:
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Where did you hear about us?
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Previous Relevant job
Company/Store Name
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Phone Number
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Address
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Supervisor
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Job Title
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Salary
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Date From
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To
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Reason for Leaving:
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May we contact your previous supervisor for a reference?
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No
Responsibilities
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Disclaimer and signature
By typing in my full name, I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
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