APPLICATION FOR EMPLOYMENT
The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion or national origin. Other laws prohibit discrimination because of age, sex, or physical handicaps.
Rumours Coffee LLC is an Equal Rights Employer.

Please note that incomplete applications will not be considered. Due to large volumes of applicants it is necessary that you fill this out entirely. If there are any issues, please explain in the additional notes field at the bottom. Thank you.
FOR RETURN PURPOSES PLEASE PUT YOU E-MAIL HERE:
E-MAIL:
PERSONAL INFORMATION
First Name: Middle Initial: Last Name: Date:
Present Address:
Street: City: State: Zip:
Permanent Address (If different from above):
Street: City: State: Zip:
Home Phone: Business Phone: Cell: E-mail:
Are you legally
Authorized or
Permitted to
work in the
United States?		 Yes
No		 Are you 16 or over?
(if under 18 a work
permit is required,
except in AZ, IL, ND
SC, SD, VA, WV):		 Yes
No		 Have you ever been convicted of a crime?*
(Answering yes to this question will not
be an absolute bar to an offer of employment:		 Yes
No
*California and Illinois applicants: Please read the *NOTICE TO APPLICANTS* section at the bottom of this application prior to answering this question.
PLACEMENT INFORMATION
Position or type of work desired: Are you interested in: Full Time
Part Time
Seasonal/Temp.
Hours
available
to work:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
AM
PM
Need more room for hours?:
Salary or Wage Desired: Date Available to Start: How Did You
Hear About
Rumours Coffee?:
Have you ever been employed or applied for a job with Rumours Coffee?: Yes
No		 If yes, when?
Skills: Check the boxes which apply to your experience:
Typing
WPM		 Data Entry
KPM		 Personal Computer 10 Key Point Of Sale Systems
Word Excel Access Quickbooks Other
Other, please list:
EDUCATION INFORMATION
List Last High School and All Business, Trade Schools & Colleges Attended
Name & Location of School
Major/Minor
Degree
Cumulative
Average
Extracurricular activities (include offices held, scholarships, awards, honors, affiliations, volunteer work, etc.) You are not required to list activities which may reveal your race religion, sex or national origin.
EMPLOYMENT INFORMATION
List all employers with current or most recent employment first. Leave no time unaccounted for. If limited previous employment, list three persons, not related to you, who have known you for an extended period of time.
Present Employer Phone Supervisors Name
Address Dates Employed: Salary
to
 Start:
Current/End:
Summary of Duties Date of Last Pay Increase:
Reason for Leaving or Seeking Change of Position
May we contact this employer? Yes No
First Previous Employer Phone Supervisors Name
Address Dates Employed: Salary
to
 Start:
Current/End:
Summary of Duties Date of Last Pay Increase:
Reason for Leaving or Seeking Change of Position
May we contact this employer? Yes No
Next Previous Employer Phone Supervisors Name
Address Dates Employed: Salary
to
 Start:
Current/End:
Summary of Duties Date of Last Pay Increase:
Reason for Leaving or Seeking Change of Position
May we contact this employer? Yes No
REFERENCES
(Not related to you)
Check One: Name Occupation Years Acquainted
Personal Reference
Occupational Reference
Address City/State/Zip Phone
//
Check One: Name Occupation Years Acquainted
Personal Reference
Occupational Reference
Address City/State/Zip Phone
/ /
Check One: Name Occupation Years Acquainted
Personal Reference
Occupational Reference
Address City/State/Zip Phone
/ /
In order for Rumours Coffee LLC to conduct reference checks, please list any other name(s) you may have worked under.
ADDITIONAL INFORMATION
Occasionally the form of an application blank makes it difficult for an individual to adequately summarize his complete back-ground. To assist us in finding the proper position for you in our company, use the space below to summarize any additional information necessary to describe your full qualifications.
PLEASE READ CAREFULLY
Applicants CERTIFICATION AND AGREEMENT
I hereby certify that the facts set forth in above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigations of my personal history.
By checking this box you agree to the above statement: I Agree