First MI Last

Address 1

Address 2

City State Zip

Phone Alternate Phone

E-Mail Address

Social Security #

Are you at least 18 years old? Yes No

Position Applying For: Barista Chef Wait Staff Other

Why are you applying for work at the Bean & Grape Cafe - Coffee & Wine Bar?

Section 2 - Education History and Training Summary:

Florida Food Manager License? Yes No
If yes, enter date of expiration:

High School - No. of years completed Did you Graduate? Yes

College/University - No. of years completed Did you Graduate? Yes

Vocational/Technical - No. of years completed Did you Graduate? Yes

Please describe any other training (e.g. on the job training)

Section 3 - Current Employer and Work Schedule:

Are you currently employed? Yes No

May we contact you employer? Yes No

If yes, list employer's name and phone:

I am available to work Full Time Part Time Either

Date available for employment:

Desired Pay: $ per hours

Final Comments:

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the Bean & Grape Cafe any and all letters, reports and other information related to my work records, with or without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application, or conveyed during any interview, which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Bean & Grape Cafe. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Bean & Grape Cafe, and that no promises or representations contrary to the foregoing are binding on the Bean & Grape Cafe unless made in writing and signed by me and the Bean & Grape Cafe's designated representative.

I have read and agree to the above statement No Yes

Sign (typing your full name serves as your signature)

You should receive an email within 72 hours notifying you that we have received your application. If you do not, please call 299.8140 or email Jeff@BeanAndGrapeCafe.com