Application For Employment

Select the location that you are applying for

Name

First NameLast Name

Email

example@example.com

Desired Position

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Have you applied here before?

YesNo

Will you be able to supply your Social Security Number if offered employment?

YesNo

Type of Employment?

Full TimePart TimeTemporary

On what date will you be able to start work?

Date

Do you have any objections to working overtime if necessary?

YesNo

Are you able to work nights or weekends?

YesNo

Can you travel if required by this position?

YesNo

Have you every been previously employed by our organization?

YesNo

Can you submit proof of legal employment authorization and identity?

YesNo

Are you 18 or older?

YesNo

Have you been convicted of a crime in the last 7 years?

YesNo

If yes, please explain (a conviction will not automatically bar employment)

Explanation

How were you referred to us?

Previous Employment | Job 1 | Date

Employer

Job Description

Previous Employment | Job 2 | Date

Employer

Job Description

Previous Employment | Job 3 | Date

Employer

Job Description

Other skills and qualifications

Summarize any job related training, skills, licenses, certificates, and/or other qualifications

High School

College

Technical Training

Other

Reference 1

Phone Number

Reference 1 Phone Number

Reference 2

Phone Number

Reference 2 Phone Number

Reference 3

Phone Number

Reference 3 Phone Number

Why do you want to work for Five Lakes?

By submitting the application you agree to the follwing. I hereby authorize Five Lakes Coffee to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information. I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law. I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.