Application for Employment

Barista

6500 Springfield Mall
Springfield, Virginia 22150

Coffee maker, ring-up sell, customer services, clean-up...

Application

*Name:
Address (street, city, zip):
Address 2 (suite/apt):
City:
State:
Zip:
Phone:
*Email Address:

Have you been convicted of a felony within the last seven years? Yes No
(If Yes, list convictions that are matter of record – these will not necessarily disqualify you for employment)

How many hours per week would you like to work?
What times are you available to work during?
What date would you be available to begin work?
Have you ever worked for Cuppy's Coffee before?(If Yes, when and where?)

Education & Skills

Education	Name & City/State of School	Last Grade Completed	Did You Graduate?	Subjects Studied/Degrees Received
High School
College
Post-College
Trade, Business or Correspondence School

Additional skills you have that may be relevant to work at Cuppy's Coffee

Previous Employer #1

Employer's Name and Location
Dates of Employment
Position & Duties
Reasons for Leaving
Supervisor's Name and Phone
May we contact?

Previous Employer #2

Employer's Name and Location
Dates of Employment
Position & Duties
Reasons for Leaving
Supervisor's Name and Phone
May we contact?

Previous Employer #3

Employer's Name and Location
Dates of Employment
Position & Duties
Reasons for Leaving
Supervisor's Name and Phone
May we contact?

Additional Interview Questions

What are you doing at present and how would a job at Cuppy's Coffee fit into your plans?
What are your future plans and how long do you foresee working at Cuppy's Coffee?
Is there anything else you think we should know about you?

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements in this application shall be ground for dismissal. I hereby authorize Cuppy's 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 Cuppy's Coffee to provide any relevant information regarding my current and/or previous employment and I release all persons, schools, employers of any and all claims for providing such information. I understand and agree that, if hired, my employment is for a definite period of time and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice. I understand that filling out this form does not indicate that there is a position open and does not obligate Cuppy's Coffee to hire me.