First Name *

Last Name *

Phone *

Email *

If under 21, please provide your date of birth:

Are you a U.S. citizen? *

Yes

Are you currently in school? *

Full Time

Part Time

Not Applicable

What is your highest level of education? *

High School Diploma

College

GED

N/A

Please list your employment history, if applicable. (This may include voluntary employment)

Previous Employment # 1 *

Company Name
Job Title/Position
Start Date
End Date

Previous Employment # 2

Company Name
Job Title/Position
Start Date
End Date

Previous Employment # 3

Company Name
Job Title/Position
Start Date
End Date

Please list any achievements in your employment or education: *

Please list any skills or training you have received. Include software and certifications, if applicable. *

Please indicate the days and times you are able to work. Please note that we are primarily looking for individuals with 5 days of availability throughout the week. Note that you will not necessarily be asked to work all the hours you are available. The information enables us to source employment opportunities according to your availability. *

If you have scheduled/religious holidays you cannot work, please specify here: *

Please indicate the amount of hours you are willing to work in a 7 day period: *

Reference # 1 *

Name
Relationship
Phone #
Email

Reference # 2 *

Name
Relationship
Phone #
Email

Reference # 3

Name
Relationship
Phone #
Email

PRIVACY STATEMENT

I warrant that:

• I have read and understand the above statement.

• I am qualified to work in the US, and if requested, can provide evidence of that fact (birth certificate, citizenship certificate, photo ID and/or working Visa, as appropriate)

• All the information I submit (including this form and any attached resume) is true and complete. I understand that any false or misleading information I provide may lead to rejection of my application, review of any employment I accept with Bart’s Crazy Good Coffee and potentially my dismissal from such employment.

Signature *

Clear

Date *