Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Full-time, Part-time *

Full-time preferred, but part-time possible

Full-time only

Part-time preferred

Part-time only

Age *

Are you 18 years or older?

Yes

No

Are you able to lift approximately 50 lbs? (Bulk stock and deliveries etc.) *

Not a deal breaker, just want to put you in a suitable area/duties.

Yes

No

Felony *

Have you ever been convicted of a felony?

Yes

No

Position desired. *

Check all that apply

Juice Bar/Counter

Register/Front

Baker

Cook

Cleaning