Capanna Coffee & Gelato


 

Application for Employment

 

 

 


      Name (last name first):


                                                                                                                         

 


      Present Address:                            City                State             Zip Code


                                                                                                                                   


      Permanent Address:                       City                State             Zip Code


                                                                                                                                   


      Phone Number:                                        Referred By:


      (           )                                                                                                          


 

      Email address:                                                                                                   


 

      Are you 18 or Older?                  If No, How old are you?                               


 

      Position Desired:                       Date You Can Start:                    Salary Desired:


                                                                                                                                   


 

     Are You Employed?     Yes            No              

 

     If so, may we inquire of your present employer?      Yes                 No                    


 

     Have you ever applied to this company before?       Yes                 No            

 

 

     Where?                                            When?                                            


                             


      Which store are you applying for?   (Circle One)    Downtown         Coralville


      Education History     

 

                       Name and location of school   Years attended   Did you graduate?   Subjects studied

 

       High School                                                                                                                           

 

       College                                                                                                                                  

 

       Trade School                                                                                                                         

 

   

 

     Subjects of special study/research work or special training/skills:

 

                                                                                                                                                   

 

                                                                                                                                                  

 

                                                                                                                                                     

 

 

     US Military or Naval Service:                          Rank:

 

                                                                                                                                                           

 

           

           

     Former Employers (list last four employers, starting with most recent):

 

      1.  Name and address of employer                       Date:   (month/year)

 

                                                                               From                To                            

 

        Salary:           Position:               Reason For Leaving:

 

                                                                                                                                          

 

 

      2.  Name and address of employer                       Date:   (month/year)

 

                                                                               From                To                            

 

        Salary:           Position:               Reason For Leaving:

 

                                                                                                                                       

 

 

      3.  Name and address of employer                       Date:   (month/year)

 

                                                                               From                To                            

 

        Salary:           Position:               Reason For Leaving:

 

                                                                                                                                       

     

 

 

     Hours of Availability         Amount of Hours Desired:               Minimum:      

 

         Mon             Tue              Wed             Thurs             Fri             Sat              Sun

 

                                                                                                                                     

 

 

     References

 

     Please give the names of three persons not related to you, whom you have known for at least one year:  

 

     Name:                    Phone #:                       Organization:                           Years Known:

 

    1.                                                                                                                                  

 

    2.                                                                                                                                  

 

    3.                                                                                                                                  

 

            Authorization: “ 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 on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”

 

Date:                           Signature                                                                              

 

Interviewed by:                                                                       Date: