JOB APPLICATION Applicant Name * First Name Last Name Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Date of Application * MM DD YYYY Employment Position Position(s) applying for: * Barista Driver Manager How did you hear about this position? * What days are you available for work? * Monday Tuesday Wednesday Thursday Friday Saturday Sunday What hours or shift are you available for work? * i.e. 9am - 5pm If needed are you available to work overtime? * On what date can you start working if you are hired? * MM DD YYYY Do you have reliable transportation to and from work? * Salary Desired: * Personal Information Have you ever applied to or worked for Lyfe Acai & Smoothie Bar, or our restaurant, The Lyfe Cafe? * If yes, when? Do you have any friends, relatives, or acquaintances working for Lyfe Acai & Smoothie Bar? * If yes, state name & relationship: Are you 18 years of age or older? * Yes No Are you a U.S. citizen or approved to work in the United States? * Yes No Do you have any condition which would require job accommodations? * If yes, please describe accommodations required. Job Skills/ Qualifications Please list the skills and qualifications you possess for the position for which you are applying: * (Note: Lyfe Acai & Smoothie Bar complies with the ADA and considers resonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.) Education and Training High School * List: Name, Location (City, State), and Year Graduated College/University List: Name, Location (City, State), and Year Graduated Vocational School/Specialized Training List: Name, Location (City, State), and Year Graduated Military Are you a member of the Armed Services? What branch of the military did you enlist? What was your military rank when discharged? How many years did you serve in the military? Previous Employment Previous Employment Please include the employer's name, job title, supervisor's name, employer address, employer telephone number, dates employed, and reason for leaving. Previous Employment Please include the employer's name, job title, supervisor's name, employer address, employer telephone number, dates employed, and reason for leaving. Previous Employment Please include the employer's name, job title, supervisor's name, employer address, employer telephone number, dates employed, and reason for leaving. References Please provide 2 personal and professional reference(s) below * Include Name, Relationship, and Phone Number Additional Information At Will Employment The relationship between you and the Lyfe Acai & Smoothie Bar is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Lyfe Acai & Smoothie Bar. No representative of Lyfe Acai & Smoothie Bar has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President. Applicant Signature * By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature. Date Submitted * MM DD YYYY Thank you!
