1855 Coffee House Application

It is the policy of 1855 Coffee House, LLC to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability, or veteran status.

Applicant Full Name*

Address*

Home Address

Street Address Line 2

City/State/ZIP

Email*

example@example.com

Primary Phone*

Job Position Applying For:*

Barista/Cafe Assistant - part timeAssistant Manager - full time

2. Date of birth*

Date

3. Are you willing to work any shift, including early mornings and weekends?

YesNo

If no, explain restrictions

4. If you are offered employment, when would you be able to begin work?

Please indicate your availability below (specific days and hours of the week):

5. Check those skills that you have. List any other skills you have that may be useful for the job you are seeking.

Answering TelephonesCustomer ServiceAble to Stand for Long Periods of TimeHandle Multiple Tasks at Once and Prioritize ThemBrew Coffee and Espresso, Steam MilkKnow The Difference Between Coffee Drinks (Red Eye, latte, Macchiato, Cappuccino, etc)Learn New Things and Have Fun!Other

6. Please indicate any current professional licenses, degrees or certifications that you hold:

7. Tell us a bit about yourself: what you do with your free time, something unique about you, your interests outside of coffee, and whatever else you would like us to know!

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held. List and explain any gaps in employment.

Business Name

Supervisor Name

Address/City/State/Zip

Job Duties

Dates of Employment (month/year-month/year)

Reason for Leaving

Business Name

Supervisor Name

Address/City/State/Zip

Job Duties

Dates of Employment (month/year-month/year)

Reason for Leaving

Business Name

Supervisor Name

Address/City/State/Zip

Job Duties

Dates of Employment (month/year-month/year)

Reason for Leaving

List any two non-relatives who would be willing to provide a reference for you.

Name

City/State

Telephone Number

Email

example@example.com

Relationship

Name

City/State

Telephone Number

Email

example@example.com

Relationship

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize 1855 Coffee House, LLC to contact former employers regarding my employment. I authorize my former employers to fully and freely communicate information regarding my previous employment, attendance, and skills. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If any employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of 1855 Coffee House, LLC, except in a specific written contract of employment signed on behalf of the organization by its Owner, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

APPLICANT SIGNATURE

Employer #1

Employer #2

Employer #3 (if applicable)

Reference #1

Reference #2