Blink Coffee Company Employment Application

Blink Coffee Company
Application for Employment

Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.

Date ______________
Last name ________________________ First name ________________ Middle name________
Street Address _________________________________________________________________
City _____________________ State _______ ZIP _______
Telephone ___________________________ Social Security # ___________________________
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.) q Yes q No
Are you looking for full-time employment? q Yes q No
If no, what hours are you available? ______________
Have you ever been convicted of a felony? (This will not necessarily affect your application.)
q Yes q No
If yes, please describe conditions. _________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Employment Desired
Position applied for __________________________________________
How did you hear of this opening? __________________________________________
Are you presently employed? q Yes q No
May we contact your present employer? q Yes q No
Date you can start_______________________________________________________________
Desired position________________________________________________________________
Desired starting salary___________________________________________________________
Please list applicable skills________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Education
School Name and Location Years Major Degree
High School _____________________________________ ______ _________________ ______
College _________________________________________ ______ _________________ ______
Graduate ________________________________________ ______ _________________ ______
Trade / Tech _____________________________________ ______ _________________ ______
Other Training ___________________________________ ______ _________________ ______
List any honors received or offices held in schools or associations.
______________________________________________________________________________
______________________________________________________________________________
In addition to your education and work history, are there are other skills, qualifications, or experience that we should consider? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Employment History (Start with most recent employer)
Company Name ________________________________________________________________
Address ________________________________________Telephone ______________________
Date Started ____________ Starting Wage ____________ Starting Position _______________
Date Ended _____________ Ending Wage ____________ Ending Position ________________
Name of Supervisor ____________________________________
May we contact? q Yes q No
Responsibilities ________________________________________________________________
______________________________________________________________________________
Reason for leaving ______________________________________________________________
Company Name ________________________________________________________________
Address _______________________________________ Telephone ______________________
Date Started ___________ Starting Wage ____________ Starting Position ________________
Date Ended _____________ Ending Wage ____________ Ending Position ________________
Name of Supervisor ____________________________________
May we contact? q Yes q No
Responsibilities ________________________________________________________________
______________________________________________________________________________
Reason for leaving ______________________________________________________________

Company Name ________________________________________________________________
Address _______________________________________ Telephone ______________________
Date Started ___________ Starting Wage ____________ Starting Position ________________
Date Ended ___________ Ending Wage ____________ Ending Position __________________
Name of Supervisor ____________________________________
May we contact? q Yes q No
Responsibilities ________________________________________________________________
______________________________________________________________________________
Reason for leaving _____________________________________________________________

References
List three personal references, not related to you, who have known you for more than one year.
Name ____________________________ Phone ____________________Years Known_______
Address ______________________________________________________________________
Name ____________________________ Phone ____________________Years Known_______
Address ______________________________________________________________________
Name ____________________________ Phone ____________________Years Known_______
Address ______________________________________________________________________


Emergency Contact
In case of emergency, please notify:
Name ______________________________________________ Phone ____________________
Address ______________________________________________________________________

Please Read Before Signing:
I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.
I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees.
In compliance with the Immigration Reform and Control Act of 1986, I understand that I may be required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment.
I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements.

Signature _______________________________________________ Date_________________



Please call 970-268-5775 if you have any questions.
Applications can be mailed, emailed or dropped off at the Mesa, CO location