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First Name
Middle Name
Last Name
Date of Birth
Address
City
State
ZIP/Postal Code
Phone
Email
Start Date
Hours Desired Per Week?—Please choose an option—Up to 8 Hours8-16 Hours16-24 Hours24-32 Hours
Pay Desired
I am interested in working at the... (Location)Lancaster LocationLititz LocationNew Holland LocationBotanical Creperie LocationAll/Does Not Matter
Position Applied For (Select all that you are interested in)Barista
Position Applied For (Select all that you are interested in)Bar/ServerKitchenBusserAny/does not matter
Position Applied For (Select all that you are interested in)BaristaKitchenBusser
Tell us about yourself!
High School
Name & Location
Did you graduate?—Please choose an option—YesNo
Subjects Studied/Degree
Current & previous sports, clubs, or activities involved in:
College
Skills/Other
Special Training
Special Skills
End Date
Company Name
Your Role/Title
Pay
Tasks Performed
Reason for Leaving
Name
Phone Number
Years Known
Please enter the times you are available during the week.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Are you able to commit to at least one Saturday a month?YesNo
Are you able to commit to at least one Sunday a month?YesNo
Do you have a drivers license?YesNo
Date
Electronic Signuature
By submitting this application, I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
