Exchange Employment Application

THE EXCHANGE COFFEE, MERCANTILE & EATERY

EMPLOYMENT APPLICATION
Full Name:*

First Name & Middle InitialLast Name
Birth Date*

MonthDayYear
Phone Number:*

Area CodePhone Number
E-mail Address:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to us?*

Walk-InEmployeeIndeedFacebookInstagramOther (please specify)Friend/Word of Mouth
Others:
Are you legally eligible for employment in the U.S.? (Proof of U.S. Citizenship or immigration status is required if hired).*

YesNo
Would you be willing to complete a drug screening if asked?*

YesNo
Have you ever been convicted of a felony? (A conviction will not necessarily bar you from employment).*

YesNo
If you answered 'Yes" to the previous question, please explain briefly.
Brief explanation of felony.
What do you like to do in your free time?*
Let us know!
- Position(s) seeking: *
- Are you seeking full-time, part-time, or seasonal employment (i.e. summer or winter break)?*
- Hours desired per week: *
- Date available to start*
  
  MonthDayYear
  Date
- Why do you want to work at The Exchange?*
- Do you have reliable transportation?*
  
  YesNoOther
- Are you currently employed?*
  
  YesNo
- If you answered 'Yes' to the previous question, what is your current occupation?
- We will need staff to cover the following hours (subject to change): Monday-Saturday, 6 am-3:30 pm. Please specify your typical hours available each day of the week (we understand this is also subject to change). *
- Please note any other schedule-related comments.
- EDUCATION. Please list High School in Row 1, College (if applicable) in Row 2, and Business/Trade School (if applicable) in Row 3.
- Please list additional skills relevant to the position(s) you are applying for: *
- Please use this section to describe your work experience, starting with your most recent or current employer.
- EMPLOYER A
- Employer*
- Dates Employed*
- Position(s) *
- Responsibilities*
- Pay blanks* per blank* (hour/week/year)
- Full or Part-time?*
  
  Full-timePart-time
- Reason for Leaving*
- Supervisor Name and Title*
- Supervisor Phone Number*
  
  Area CodePhone Number
- May we contact them?*
  
  YesNo
- If you answered 'No' for the previous question, please explain briefly.
- EMPLOYER B
- Employer*
- Dates Employed*
- Position(s) *
- Responsibilities*
- Pay blanks* per blank* (hour/week/year)
- Full or Part-time?*
  
  Full-timePart-time
- Reason for Leaving*
- Supervisor Name and Title*
- Supervisor Phone Number*
  
  Area CodePhone Number
- May we contact them?*
  
  YesNo
- If you answered 'No' for the previous question, please explain briefly.
- EMPLOYER C
- Employer
- Position(s)
- Responsibilities
- Pay blanks per blank (hour/week/year)
- Full or Part-time?
  
  Full-timePart-time
- Reason for Leaving
- Supervisor Name and Title
- Supervisor Phone Number
  
  Area CodePhone Number
- May we contact them?
  
  YesNo
- If you answered 'No' for the previous question, please explain briefly.
- The information in this application is true and correct to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in termination.
- Signature
- Date
  
  MonthDayYear
  Date
- Should be Empty: