EMPLOYEE APPLICATION I am interested in: * Part Time Full Time Hours Per Week Desired: * PERSONAL INFORMATION Name * First Name Last Name Phone * (###) ### #### Email Address * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Are You Authorized To Work In The United States? * Yes No Have You Ever Been Convicted Of A Felony? * Yes No If Selected For Employment, Are You Willing To Submit To A Pre-Employment Background Check? * Yes No EDUCATION * Please include School name, Location, Years Attended, Degree Received & Major. EMPLOYMENT HISTORY Please start with your most recent employer. EMPLOYER * Dates Employed From * MM DD YYYY Dates Employed To MM DD YYYY Pay Rate * $ Work Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Your Position Duties Performed * Reason(s) for Leaving * Supervisor's Name * First Name Last Name Supervisor's Position * May We Contact Them? * Yes No Employer Dates Employed From MM DD YYYY Dates Employed To MM DD YYYY Pay Rate $ Work Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Your Position Duties Performed Reason(s) for Leaving Supervisor's Name Supervisor's Position May We Contact Them Yes No REFERENCES Name * First Name Last Name Phone * (###) ### #### Company / Relationship * Name * First Name Last Name Phone * (###) ### #### Company / Relationship * Acknowledgement & Authorization By providing your name below and submitting this application for employment, you agree to the following: • I certify that all answers given herein are true to the best of my knowledge. • I authorize investigation of all statements contained in this application for employment as ma be necessary in arriving at an employment decision. • In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. Your Name * First Name Last Name Today's Date * MM DD YYYY Thank you for your interest in Nova Espresso. We have received your application and will reach out if we feel like you fit what we need at this time.If you have any questions, please reach out to us at info@novaespresso.coffee
