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Apply at La Barista
First Name
Last Name
Email
Phone
Address
City
US State
Zip Code
Have You Been Convicted of a Felony?
What Days of the Week Are You Available?
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What Hours of the Day Are You Available?
Which Shifts Are You Able to Work?
5:15 AM to 12 PM
12 PM to 6:45 PM
Are You Employed Now?
If Yes, Do You Wish to Stay at Your Present Place of Employment?
Expected Hourly Rate
Expected Weekly Earnings
Date You Can Start
Have Your Applied at La Barista Before?
Yes
No
How Did You Hear About This Position?
Work History
Current or Most Recent
Previous Job Title
Previous Employer, Address, and Telephone
Name of Immediate Supervisor
Date Previous Job Started
Date Previous Job Ended
Previous Job Description
Pay
Reason For Leaving
May We Contact?
Next Most Recent
Previous Job Title
Previous Employer, Address, and Telephone
Name of Immediate Supervisor
Date Previous Job Started
Date Previous Job Ended
Previous Job Description
Pay
Reason For Leaving
May We Contact?
Next Most Recent
Previous Job Title
Previous Employer, Address, and Telephone
Name of Immediate Supervisor
Date Previous Job Started
Date Previous Job Ended
Previous Job Description
Pay
Reason For Leaving
May We Contact?
Education
High School
Last Year Completed
9th
10th
11th
12th
Received Diploma?
Yes
No
College/University
Last Year Completed
1
2
3
4
Degree and Major
List Any Applicable Special Skills, Training, or Proficiencies
Disclaimer
By submitting, I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired. I also provide consent for former employers to be contacted regarding work records.
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