Place for Application (You may select multiple)
Drink DownDrink UpSpinZeno CafeKarmaReverseManhattansPlanet BearchNew YorkCream

——————————————- PERSONAL INFORMATION ——————————————

NAME (LAST NAME, FIRST NAME, M.I.)
 

SOCIAL SECURITY NUMBER
 

ADDRESS
 

CITY
 

STATE
 

ZIP
 

PHONE
 

E-MAIL
 

REFERRED BY
 

——————————————- EMPLOYMENT DESIRED ——————————————-

POSITION APPLYING FOR
 

DATE YOU CAN START
 

DESIRED SALARY
 

MAY WE CONTACT YOUR CURRENT EMPLOYER?
YesNo

ARE YOU LEGALLY AUTHORIZED TO WORK IN THE US?
YesNo

HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE?
YesNo

IF SO WHERE?
 

——————————————- EDUCATION HISTORY ——————————————-

HIGH SCHOOL/
 

HIGH SCHOOL/YEARS ATTENDED
 

DID YOU GRADUATE
YesNo

COLLEGE OR TRADE SCHOOL/YEARS ATTENDED
 

DID YOU GRADUATE
YesNo

SUBJECT
 

——————————————- GENERAL INFORMATION ——————————————

SUBJECTS OF SPECIAL STUDY / RESEARCH WORK
 

SPECIAL TRAINING
 

SPECIAL SKILLS
 

U.S. MILITARY SERVICE / RANK
 

——————————————- DECLARATION OF AVAILABILITY ———————

NUMBER OF HOURS PREFERRED PER WEEK
 

PLEASE INDICATE YOUR AVAILABILITY BELOW. WRITE THE EARLIEST AND THE LATEST TIME YOU CAN WORK FOR EACH DAY OF THE WEEK

——————————————- PREVIOUS EMPLOYMENT ——————————————

LAST EMPLOYER 1
 

From
 

TO
 

LAST EMPLOYER 1 – ADDRESS
 

SALARY/POSITION
 

REASON FOR LEAVING
 

LAST EMPLOYER 2
 

From
 

TO
 

LAST EMPLOYER 2 – ADDRESS
 

SALARY/POSITION
 

REASON FOR LEAVING
 

LAST EMPLOYER 3
 

From
 

TO
 

LAST EMPLOYER 3 – ADDRESS
 

SALARY/POSITION
 

REASON FOR LEAVING
 

——————————————- REFERENCES ——————————————

NAME/PHONE/YEARS KNOWN
 

NAME/PHONE/YEARS KNOWN
 

NAME/PHONE/YEARS KNOWN
 

——————————————- AUTHORIZATION ——————————————

BY TYPING MY FULL NAME BELOW I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE
 

DATE
 

Finished