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Job Application
Name
Date
Address
Zip
City
State
Phone
Email
Date Available
Social Security No
Desired Salary $
Position Applied For
Barista
Shift Supervisor
Store Manager
Kitchen Staff
Others
Are you Citizen of U.S?
Yes
No
If no, Are you authorize to work in U.S?
Yes
No
Have you ever been convicted of a felony?
Yes
No
If yes, explain:
Education
High School
Address
From
To
Did you graduate?
Yes
No
Diploma
College
Address
From
To
Did you graduate?
Yes
No
Degree
Others
Address
From
To
Did you graduate?
Yes
No
Degree
References
Full Name Reference 1
Relationship
Company
Phone Number
Address
Full Name Reference 2
Relationship
Company
Phone Number
Address
Previous Employment
Company
Phone Number
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
Disclaimer and Signature
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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