PERSONAL INFORMATION (Please print)

 Name: Last_______________________       First ___________________       Middle___________                

 Social Security Number  ________-_______-_________

Today's Date ______/______/______     Date of Birth ______/______/______ 

 Are you less than 18 years of age?  Yes___ No___

Are you legally eligible for employment in the US? Yes ___ No ___

Have you been convicted of a crime in the last seven (7) years? Yes ___ No ___

 If Yes, please attach a list of convictions that are a matter of public record. A conviction will not necessarily disqualify you for employment.

Present Address        Street                                     City                State/Province             Zip Code

Permanent Address   Street                                     City                State/Province             Zip Code

Phone Number          Daytime                                  Evening                Cell                                  Referred By

EMPLOYMENT DESIRED
Position

Are you able to work overtime?

EDUCATION

List skills relevant to the position applied for _________________________________________________________

FORMER EMPLOYERS   List below current and last three employers, starting with the most recent first.

From:

 To:

Salary

May we contact?

From:

 To:

Salary

May we contact?

From:

 To:

Salary

May we contact?

From:

 To:

Salary

May we contact?

REFERENCES  Give below the names of three professional references, who you have known at least one year.

 Name               Address and Phone Number                           Business                How do you know this person?

 I hereby authorize Cowgirls Espresso to thoroughly investigate my background, references, employment record and other matters related to my suitability for employment. I authorize persons, schools, my current employer (if applicable), and previous employers and organizations contacted by Cowgirls Espresso to provide any relevant information regarding my current and/or previous employment and I release all persons, schools, employers of any and all claims for providing such information. I understand that misrepresentation or omission of facts may result in rejection of this application, or if hired, discipline up to and including dismissal. I understand that I may be required to sign a confidentiality and/or non-compete agreement, should I become an employee of Cowgirls Espresso. I understand that nothing contained in this application, or conveyed during any interview which may be granted, is intended to create an employment contract. I understand that filling out this form does not indicate there is a position open and does not obligate Cowgirls Espresso to hire me. I understand and agree that my employment is at will, which means that it is for no specified period and may be terminated by me or Cowgirls Espresso at any time without prior notice for any reason.

Date _______________________ Signature ____________________________________________________________________