Application

You can pick up this Application at any time at Chaye Tea. Just come in and ask for one! You will just be asked a couple pre-interview questions.

We hire employees who are devoted to customer service. They must be efficient, hard working and they have to have a great attitude at all times. We like to see prior experience but we do accept applicants who do not have any depending on their work ethic.

Child Labor Laws 

Template for Application

Application for Employment

Independently Owned and Not a Franchise

An Equal Opportunity Employer

Personal

Name (Last, First, Middle) :
Social Security Number:
Telephone:
Address (City, State, Zip code):
Are you 18 years old or over? Yes or No
If not can you provide a work permit? Yes or No 
Minors will not be permitted to work unless they are legally able to do so under all applicable state and federal laws. A minor may only be permitted to work in accordance with the terms,restrictions and limitations set forth in their work permit, if one is required.

Employment Desired

Position Desired:

Pay Expected:

How did you learn about this establishment?

Date available to start:

Are you available to work on weekends or holidays?

Hours Available	Sun.	Mon.	Tues.	Wed.	Thurs.	Fri.	Sat.	Total Hours Per Week
From								Would You Work Full Time or Part Time
To								Shift preferred Days  Nights Weekends

General Information

Have you ever worked for a coffee, tea or food place?  If yes, when and where?

What was your supervisor’s name?

What was your reason for leaving?

Do you have any friends or family that works at Chaye Tea?

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR SERIOUS MISDEMEANOR? �� YES �� NO

IF YES, STATE NATURE OF CRIME(S), WHEN AND WHERE CONVICTED AND DISPOSITION OF THE CASE. CA LOCATIONS - CONVICTIONS FOR MARIJUANA

RELATED OFFENSES MORE THAN 2 YEARS OLD NEED NOT BE DISCLOSED:

*NOTE: No applicant will be denied employment solely on the basis of conviction of a criminal

*NOTE: No applicant will be denied employment solely on the basis of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding

circustances and the relevance of the offense to the position(s) applied for, however, may be considered.

ARE YOU ABLE TO PERFORM ALL OF THE ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING, WITH OR WITHOUT A REASONABLE

ACCOMMODATION? �� YES �� NO

IF NECESSARY, PLEASE DESCRIBE THE TYPE(S) OF REASONABLE ACCOMMODATIONS THAT ARE NEEDED?

HAVE YOU EVER BEEN COUNSELED FOR CASH HANDLING SITUATIONS (OVER/SHORT), CUSTOMER SERVICE ISSUES OR INABILITY TO MEET/ADHERE TOCOMPANY STANDARDS? �� YES �� NO

IF YES, PLEASE EXPLAIN:

Educational History

School	Name and Location	Course of Study	Level or years completed	Type of degree or certificate
High School
College/Other
Are You Going to School Now?	Yes    or    No	DAY CLASSES �� NIGHT CLASSES ��

Identification Requirements

CAN YOU SUBMIT VERIFICATION OF YOUR LEGAL RIGHT TO WORK IN THE UNITED STATES? �� YES �� NO

YOU WILL BE REQUIRED TO PROVIDE NECESSARY PROOF OF YOUR ELIGIBILITY AND LEGAL AUTHORIZATION TO WORK IN THE UNITED STATES AS

PROVIDED UNDER THE IMMIGRATION REFORM AND CONTROL ACT OF 1986 (IRCA). PLEASE REFER TO THE LISTS OF ACCEPTABLE DOCUMENTS TOESTABLISH WHICH DOCUMENTS YOU MAY PRESENT, AFTER HIRED, TO ESTABLISH YOUR IDENTITY AND LEGAL AUTHORITY TO WORK IN THE U.S.

Employment History

From:	To:			Last or present employers name and complete address
Starting Wage $            per		Ending Wage $           per			Your Job Title	Supervisors Name	Telephone

Description of Duties:
Reason for Leaving:	May we Contact this employer?

Any other Employment History?

From:	To:			Last or present employers name and complete address
Starting Wage $            per		Ending Wage $           per			Your Job Title	Supervisors Name	Telephone

PLEASE READ AND SIGN BELOW

I HEREBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION FORM IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE ANDAGREE TO HAVE ANY OF THE STATEMENTS CHECKED BY GLORIA JEAN’S COFFEES, I VOLUNTARILY ANDKNOWINGLY AUTHORIZE ANY PRESENT ORPAST EMPLOYER OR SUPERVISOR; COLLEGE OR UNIVERSITY OR OTHER INSTITUTION OF LEARNING; ADMINISTRATOR; LAW ENFORCEMENTAGENCY, STATE AGENCY, LOCAL AGENCY, FEDERAL AGENCY, PRIVATE BUSINESS, MILITARY BRANCH OR THE NATIONAL PERSONNEL RECORDSCENTER, PERSONAL REFERENCE AND/OR ANY OTHER PERSONS TO GIVE RECORDS OR INFORMATION THEY MAY HAVE CONCERNING MY CRIMINALHISTORY, MOTOR VEHICLE HISTORY, SOCIAL SECURITY NUMBER, EARNINGS HISTORY, CHARACTER, AND EMPLOYMENT (INCLUDING REASONS FORTERMINATION) OR ANY OTHER INFORMATION REQUESTED BY GLORIA JEAN’S COFFEES. FURTHER, I RELEASE ALL PARTIES AND PERSONS FROMANY AND ALL LIABILITY FOR ANY DAMAGES THAT MAY RESULT FROM FURNISHING SUCH INFORMATION TO THE COMPANY AS WELL AS FROM THE USEOR DISCLOSURE OF SUCH INFORMATION BY THE COMPANY OR ANY OF ITS AGENTS, EMPLOYEES, OR REPRESENTATIVES.

I UNDERSTAND THAT ANY MISREPRESENTATION, FALSIFICATION, OR MATERIAL OMISSION OF INFORMATION ON THIS APPLICATION MAY RESULT IN MYFAILURE TO RECEIVE AN OFFER OR, IF I AM HIRED, IN MY IMMEDIATE DISMISSAL FROM THE COMPANY. IN CONSIDERATION OF MY EMPLOYMENT, IAGREE TO CONFORM TO THE RULES AND STANDARDS OF THE COMPANY AND I ACKNOWLEDGE THAT MY EMPLOYMENT AT GLORIA JEAN’S COFFEESIS FOR NO DEFINITE PERIOD OF TIME AND THAT THIS NOTHING IN THIS APPLICATION SHALL CONSTITUTE A CONTRACT OF EMPLOYMENT ORGUARANTEE OF EMPLOYMENT. I AGREE THAT MY EMPLOYMENT IS “AT-WILL” MEANING THE TERMS OF EMPLOYMENT MAY BE CHANGED AT ANY TIME,FOR ANY REASON, WITH OR WITHOUT NOTICE AND WITH OR WITHOUT CAUSE, EITHER AT MY OPTION OR AT THE OPTION OF THE COMPANY. THIS

INCLUDES BUT IS NOT LIMITED TO: TERMINATION, DEMOTION, PROMOTION, TRANSFER, COMPENSATION, BENEFITS, DUTIES, AND LOCATION OFWORK. MY STATUS AS AN “AT-WILL” EMPLOYEE CANNOT BE CHANGED.FURTHER, I UNDERSTAND THAT ALL OFFERS OF EMPLOYMENT ARE CONDITIONED ON THE RECEIPT OF SATISFACTORY RESPONSES TO REFERENCE

REQUESTS, SATISFACTORY PROOF OF AN APPLICANT’S IDENTITY AND LEGAL AUTHORITY TO WORK IN THE UNITED STATES.

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Applicants Signature                                                                                                                                Date