General Information

Social Security Number
Name
Address
City
State
Zip Code
Home Phone Ex:
(555)555-5555
Cell Phone



Availability


Total hours
avalible per week

Are you legally able
to be employed in
the United States?
YES
NO



Weekly Hours Available

Please provide the daily hours your available to work below.

Sunday From: To:
Monday From: To:
Tuesday From: To:
Wednesday From: To:
Thursday From: To:
Friday From: To:
Saturday From: To:






High School Information


School
Last Grade Completed
GPA
Teacher Reference
Class
Counselor
Sports or Activities






Post High School Education


School
Graduation Date (or anticipated date)
GPA
Major or Area of Study
Teacher Reference






Job History

List your three most recent jobs below.

(1st)

Company
Address
City
State
Phone
Job Description
Supervisor
Dates Worked From: To:
Salary
Reason for Leaving

(2nd)

Company
Address
City
State
Phone
Job Description
Supervisor
Dates Worked From: To:
Salary
Reason for Leaving

(3rd)

Company
Address
City
State
Phone
Job Description
Supervisor
Dates Worked From: To:
Salary
Reason for Leaving


Personal References


Name
Address
Home Phone


Name
Address
Home Phone


Name
Address
Home Phone




During the past 7 years have you been convicted of,
pled guitly to, or pled no contest to a crime
(excluding misdameanors and traffic violations).
YES
NO
If Yes Describe in full.



By sending this form you have agreed to the following
1. I certify that I have read and fully completed allo of this application and that the information contained on this application is correct to the best of my knowledge and understand that any omission or erroneous infromation is grounds for dismissal.
2. I authorize the reference listed on this apllication to give you any and all information concerning my previous employment, personal or otherwise and I release all parties from liability for any damage that may result from funishing same to you.
3.Coffe Crossing LLC, is an Equal Opportunity Employer. Various Frederal State and Local laws prohibit descrimination by race, color, religion, sex , age, national origin, disability or veterans status. It is our policy to fully comply with these laws; information in this application will not be used for any purpose prohibited by law.