Employee Application

Name *

Date *

Telephone *

Email Address *

Address, City, and Zip Code *

Type of Employment Desired *

Full TimePart Time

Date Available to Start Work *

How many hours a week are you willing to work? *

Are you willing to make a commitment to work for at least one year? *

YesNo

Do you have dependable transportation to work? *

YesNo

You may occasionally be requested to work 'after hours' for special events or to clean up. Do you have any objection to extra hours of work? *

YesNo

Are you legally permitted to work in the United States? *

YesNo

Have you ever plead "guilty", "no contest", or been convicted of a felony or misdemeanor involving financial matters? *

YesNo

If yes, please explain: (a conviction will not automatically bar employment)

Do you like Coffee?

YesNo

Do you drink coffee and/or espresso?

YesNo

If yes, what do you like to drink?

Work Hours

Hours
Avaliable

Hours NOT Avaliable

Mon

6:00am-
4:30pm

Tues

6:00am-
4:30pm

Weds

6:00am-
4:30pm

Thurs

6:00am-
4:30pm

Fri

6:00am-
4:30pm

Sat

6:30am-
4:30pm

Sun

6:30am-
4:30pm

EMPLOYMENT HISTORY

Please provide all employment information for your past three employers starting with the most recent.

Employer:

Position Held:

Address:

Telephone Number:

Immediate Supervisor and Title:

Dates Employed:

Job Summary:

Reason for Leaving:

Please Advise if you have any objection to our contacting your supervisor:

Employer:

Position Held:

Address:

Telephone Number:

Immediate Supervisor and Title:

Dates Employed:

Job Summary:

Reason for Leaving:

Please Advise if you have any objection to our contacting your supervisor:

Employer:

Position Held:

Address:

Telephone Number:

Immediate Supervisor and Title:

Dates Employed:

Job Summary:

Reason for Leaving:

Please Advise if you have any objection to our contacting your supervisor:

PERSONAL REFERENCE

Please provide information for two personal references

Name

Relationship to You

Address:

Telephone Number:

Years Known

Name

Relationship to You

Address:

Telephone Number:

Years Known

High School

College

Graduate

Technical /Trade

Name of School

City/State

Last Year Completed

GPA

Still Attending?

Do you have experience working with coffee or food? How was it?

What is coffee, anyway?

What is your favorite thing to cook, and why?

Why would you like to work at Mile 42 Coffee?

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of the information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. If I am employed, I acknowledge that there is no specific length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent I have read and fully understand the foregoing, and that I seek employment under these conditions by submitting this applicaiton.