Please email completed applications to [email protected] Please complete entire application to ensure processing. Copper Canyon Coffee Employment Application Date _______________________ Personal Information (Please Print) Last Name _____________________________________ First ____________________ Middle Initial ______ Address ________________________________________ City ________________ State ____ Zip ________ Home Phone __________________________________ Cell Phone __________________________________ Email Address _____________________________________________________________________________ Best time of day to reach you? !
Morning
!
Evening Are you over 16 years of age? !
Yes
!
No !
Yes
Do you have reliable means of transportation to a job? Are you eligible to work in the United States? !
Yes
(Proof of eligibility will be required upon employment) Have you ever been convicted of a felony? !
Yes
!
!
No !
No No If Yes, list convictions that are a matter of public record (arrests are not convictions). A conviction will not necessarily disqualify you for employment. ____________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ POSITION & AVAILABILITY Position applying for: ________________________________________________________________________ Location: !
Café
Shift: !
Part-‐Time
!
Roasting Facility !
Full-‐Time
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Seasonal Only Wage desired $ _____________________________ Date you can start:________________________________ Specify times available for each day of the week: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY EDUCATION List names and addresses of schools Circle Last Year Completed Did You Graduate? Degrees Received or Major/Minor High School 1 2 3 4 Y N College 1 2 3 4 Y N Grad School 1 2 3 4 Y N Trade or Business School 1 2 3 4 Y N List skills relevant to position applied for ________________________________________________________ _________________________________________________________________________________________ What do you like about coffee? _______________________________________________________________ _________________________________________________________________________________________ What was your best coffee shop experience? ____________________________________________________ _________________________________________________________________________________________ Why would you like to work for Copper Canyon Coffee? ___________________________________________ _________________________________________________________________________________________ Describe a situation where you provided excellent customer service in your recent position. How/Why was this effective with the customer? ____________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ FORMER EMPLOYERS List below current and last three employers, starting with most recent one first. Please complete even if you attach a résumé. DATE (MM/DD/YY) From CURRENT EMPLOYER (Name & Address) To 1 SALARY OR HOURLY Starting $______________ Ending $_______________ If hourly, average # of hours per week_________ POSITION REASON FOR LEAVING DUTIES PERFORMED SUPERVISOR’S NAME PHONE # MAY WE CONTACT? DATE (MM/DD/YY) From CURRENT EMPLOYER (Name & Address) To 2 SALARY OR HOURLY Starting $______________ Ending $_______________ If hourly, average # of hours per week_________ POSITION REASON FOR LEAVING DUTIES PERFORMED SUPERVISOR’S NAME PHONE # MAY WE CONTACT? DATE (MM/DD/YY) From CURRENT EMPLOYER (Name & Address) To 3 SALARY OR HOURLY Starting $______________ Ending $_______________ If hourly, average # of hours per week_________ POSITION REASON FOR LEAVING DUTIES PERFORMED SUPERVISOR’S NAME PHONE # MAY WE CONTACT? DATE (MM/DD/YY) From To 4 CURRENT EMPLOYER (Name & Address) SALARY OR HOURLY Starting $______________ Ending $_______________ If hourly, average # of hours per week_________ POSITION REASON FOR LEAVING DUTIES PERFORMED SUPERVISOR’S NAME PHONE # MAY WE CONTACT? REFERENCES List the names of three professional non-‐relative references, whom you have known for at least a year. NAME ADDRESS & PHONE NUMBER BUSINESS YEARS ACQUAINTED; HOW DO YOU KNOW THIS PERSON? 1 2 3 I hereby authorize Copper Canyon Coffee to thoroughly investigate my background, references, employment record and other matters related to my suitability for employment. I authorize persons, schools, my current employer (if applicable), and previous employers and organizations contacted by Copper Canyon Coffee to provide any relevant information regarding my current and/or previous employment and I release all persons, schools, and 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 termination. I understand that I may be required to sign a confidentiality and/or non-‐compete agreement, should I become an employee of Copper Canyon Coffee. 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 Copper Canyon Coffee to hire me. I understand and agree that my employment is at will, which means that it is for no specified period and may be terminated by me or Copper Canyon Coffee at any time without prior notice for any reason. Signature ___________________________________________________________ Date __________________ Copper Canyon Coffee is an equal opportunity employer, dedicated to a policy of non-‐discrimination in employment on any basis including race, color, age, sex, religion, national origin, the presence of mental, physical, or sensory disability, sexual orientation, or any other basis prohibited by federal, state, or provincial law.