Online Application - Perkup Espresso

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Are you less than 18 years of age?

Yes
No

Are you legally eligible for employment in the U.S.?

Yes
No

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

Yes
No

If yes, list convictions that are a matter of public record (arrests are not convictions)

Convictions that are a matter of public record:

EMPLOYMENT DESIRED

(If you are applying for a retail hourly position, please keep in mind that the availability of hours may vary)

Describe your schedule availability

Position desired:

Location desired

Date you can start

Are you able to work overtime?

Yes
No

Have you ever worked for Perkup Espresso? If yes, when and where?

Yes
No

Dates and location of previous Perkup Espresso employment:

EDUCATION

High School name and address

Last year completed

Did you graduate?

Yes
No

Subjects studied and degrees received

College name and address

Last year completed

Did you graduate?

Yes
No

Subjects studied and degrees received

Other school name and address

Last year completed

Did you graduate?

Yes
No

Subjects studied and degrees received

List skills relevant to the position you are applying for

Have you ever visited a Perkup Espresso location before? Where? Describe your experience:

Describe why you would be a good candidate for a Barista in a coffee drive-thru?

EMPLOYMENT HISTORY

1. Name and Address of Place of Employment - Type of Business

Supervisor name and phone number

Position

Dates employed

Starting salary - ending salary

Duties performed

Reason for leaving

2. Name and Address of Place of Employment - Type of Business

Supervisor name and phone number

Position

Dates employed

Starting salary - ending salary

Duties performed

Reason for leaving

3. Name and Address of Place of Employment - Type of Business

Supervisor name and phone number

Position

Dates employed

Starting salary - ending salary

Duties performed

Reason for leaving

4. Name and Address of Place of Employment - Type of Business

Supervisor name and phone number

Position

Dates employed

Starting salary - ending salary

Duties performed

Reason for leaving

REFERENCES

You may list personal and/or business references

1. Name

First Last

Phone

Address

How acquainted?

How long?

2. Name

First Last

Phone

Address

How acquainted?

How long?

3. Name

First Last

Phone

Address

How acquainted?

How long?

4. Name

First Last

Phone

Address

How acquainted?

How long?

SUBMIT

I hereby authorize Perkup Espresso to thoroughly investigate my background, references, employment record and other matters related to my suitability for employment. I hereby authorize the above schools, references and former (and/or present) employers to give or verify any information they have regarding me, and I release all schools, references and former (and/or present) employers of any and all claims for providing such information. I understand that misrepresentation or omission of facts may result in rejection of this application, or if hired, discipline up to and including dismissal. I understand that I may be required to sign a confidentiality and/or non-compete agreement, should I become an employee of Perkup Espresso, I understand that nothing contained in this application, or conveyed during any interview which may be granted, is intended to create an employment contract. I understand that filling out this form does not indicate there is a position open and does not obligate Perkup Espresso to hire me. I understand that my employment is at will, which means employment with this company is not for a definite period of time and is based on the mutual consent of each employee and the company.

Today's date

Full name printed