Personal Information Name * First Name Last Name Date of Birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Introduction Start Date * MM DD YYYY Hours Desired Per Week * Up to 8 hours 8 - 16 hours 16 - 24 hours 24 - 32 hours Desired Pay * $ Desired Location * New Holland Coffee - New Holland New Holland Coffee - Lancaster Botanical Creperie Any Location Desired Position * Barista Kitchen (NHCC - New Holland Only) Busser (NHCC - New Holland Only) Any Position Tell us about yourself! * Education High School Sports, clubs, or activities involved in: Include any you have been or are planning on being a part of. Graduated Yes No Currently Enrolled College Graduated Yes No Currently Enrolled Previous Employer 1 Company Name Start & End Dates Position Held Pay $ Job Duties Reason for Leaving Previous Employer 2 Company Name Start & End Dates Position Held Pay $ Job Duties Reason for Leaving Reference 1 Name First Name Last Name Phone (###) ### #### Years Known Relation Reference 2 Name First Name Last Name Phone (###) ### #### Years Known Relation Schedule Availability Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Sundays Do you have a driver's license? * Yes No Are you able to commit to working one weekend a month? * Yes No Thank you! Your application has been received!
