Employment Application

 

CUPZ, LLC 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 local law.

Please complete the entire application to ensure processing

Personal Information

Today's Date:

Full Name:

Social Security Number:

Street Address:

City, State, Zip:

Former Address:

City, State, Zip:

E-Mail:

Phone Number(s):

Daytime
Evening
Cell phone

Are you legally eligible for employment in the U.S.?
(Proof of U.S. citizenship or immigration status will be required if hired for a position.) 

Are you less than 18 years of age?
(CUPZ is required to comply with federal, state, or local law.) 

Have you been convicted of a felonyin the last seven (7) years?
(If Yes, list convictions that are a matter of public record.  A conviction will not
necessarily disqualify you for employment.

Other Names you are known by.

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

Position:

Salary Desired:

Specify Hours available to work each day of the week

Sunday
 

Monday
 

Tuesday
 

Wednesday
 

Thursday
 

Friday
 

Saturday
 

Are you able to work overtime?

Education

High School (List the name & address of school, years attended, did you graduate?).

College or University (List the name & address of school, years attended, did you graduate?, subjects studied and degree received.).

Post College (List the name & address of school, years attended, did you graduate?, subjects studied and degree received.).

Trade, Business, or Correspondence School (List the name & address of school, years attended, did you graduate?, subjects studied and degrees or certificates received.).

List skills that you possess that are relevant to the position applied for:

Former Employers 
(List below current and last three employers, starting with the most recent one.  Please include any non-paid/volunteer experience which is related to the job for which you are applying..)

From
To      

Current or Last Employer (name, address, type of business)
 

Salary or Hourly
Start 
End    
 


Reason for Leaving
 

Duties Performed

Supervisor's Name:    Phone Number:    May we contact?

.


From
To      

Previous Employer
(name, address, type of business)
 

Salary or Hourly
Start 
End    
 


Reason for Leaving
 

Duties Performed

Supervisor's Name:    Phone Number:    May we contact?


From
To      

Previous Employer
(name, address, type of business)
 

Salary or Hourly
Start 
End    
 


Reason for Leaving
 

Duties Performed

Supervisor's Name:    Phone Number:    May we contact?


From
To      

Previous Employer
(name, address, type of business)
 

Salary or Hourly
Start 
End    
 


Reason for Leaving
 

Duties Performed

Supervisor's Name:    Phone Number:    May we contact?


References (give below the names of three professional references, whom you've known for at least one year.)

Name

Address & Phone #

Name of Business

Years acquainted

Please use the space below to tell, in your own words, why you would like to work for CUPZ, LLC, why you think you would be asset to our company, and what experiences you've had in a coffee shop (or similar) location either as an employee or as a customer.

I hereby authorized CUPZ, LLC, its affiliates and/or agents, 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 CUPZ, LLC 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 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 be come an employee of CUPZ, LLC.  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 CUPZ, LLC to hire me.  I understand and agree that my employment is at will, which means that it is for no specific period and may be terminated by me or CUPZ, LLC at any time without prior notice for any reason.

Date:

Typing my name and social security number in the following box shall hereby serve as my duly executed signature.