Application for Employment – STARBUCKS @ TWELVE ATLANTIC STATION

PLEASE ENTER ALL INFORMATION, PRINT AND SUBMIT.
SIGN PRINTED COPY AND BRING TO THE INTERVIEW.

PERSONAL INFORMATION

First Name and MI:		SSN(if applicable):
Last Name:		Email Address:
Street Address:		Home Phone:
		Cell Phone:
City:		Work Phone:
State:	Zip:	Yes No	May we contact you at work?

Other names under which you have worked:
Position Desired:
Date Available for Work
Full Time Part Time Temporary	If Temporary, from:		to:
Day and times NOT available to work:
Minimum Salary Expectation:
Are you 18 years of age or older?		Yes No
Are you able to perform the essential functions of the position for which you have applied, with or without reasonable accommodation?		Yes No
Are you prevented from becoming lawfully employed because of visa or immigration status?		Yes No
Have you ever been convicted of or pled guilty to a felony?		Yes No
If yes, please explain:

EDUCATION

	Name and Location	Diploma/Degree	Major/Course Certification/Degree

High School		Diploma? Yes No GED

College		Degree? Yes No Last Yr Attended:

Other		Degree? Yes No Last Yr Attended:

MILITARY EXPERIENCE

Were you in the military service?	Yes No
If yes, what branch and rank at separation?
Briefly describe your duties and any special training and/or skills.

NOVARE HISTORY

Have you applied to TWELVE Hotels & Residences, Novare Group Holdings or Starbucks @ TWELVE Atlantic Station before?	Yes No
Where? When?

Have you been previously employed by TWELVE Hotels & Residences, Novare Group Holdings or Starbucks @ TWELVE Atlantic Station?	Yes No
When?
Reason for leaving:

Were you referred to us by a current TWELVE Hotels & Residences or Starbucks @ TWELVE Atlantic Station employee? If yes, please provide associate's name:

Do you have any relatives currently working for us? If yes, please indicate names and positions:

EMPLOYMENT HISTORY

State the following: (identify your last three employers, starting with the most current).

May we contact your current employer? Yes No

Employer Name:		Phone:
Employer Address:
Supervisor Name:		Title:
Your Job Title and Duties:
Starting Salary:		Ending Salary:
Reason for Leaving:
Employed From:		To:

Employer Name:		Phone:
Employer Address:
Supervisor Name:		Title:
Your Job Title and Duties:
Starting Salary:		Ending Salary:
Reason for Leaving:
Employed From:		To:

Employer Name:		Phone:
Employer Address:
Supervisor Name:		Title:
Your Job Title and Duties:
Starting Salary:		Ending Salary:
Reason for Leaving:
Employed From:		To:

REFERENCES

Give the names of three persons you have known at least one year and who are not related to you.

	Name	Address/Phone (or email)	Business	Years Acquainted
1
2
3

In case of emergency contact:

Name:
Address:
Phone Number:		Alternate Number:
Relationship:

CERTIFICATE OF APPLICANT (READ CAREFULLY BEFORE SIGNING)

I certify that the information in this application (and accompanying resume or information) is true. I also agree and understand that misrepresentations or false or omitted facts may disqualify me from further consideration for employment and may be considered justification for my termination if discovered at a later date.
I authorize investigation of the statements contained herein and the references listed above to give you any and all information such persons, schools, and employers or organizations may have, and release all parties from all liability for any damage that may result from furnishing this information to you. I authorize you to request and receive any and all information from my entire work and personal history.
I understand that, if hired, my employment is for no definite period and may be terminated at any time, with or without cause, at the discretion of either the company or myself. I understand that I will remain an at will employee and can be terminated at any time without any notice, absent a written contract signed by the President of the Company and myself. If I am employed, it is also understood that the Company, at its sole option and without prior notice, can change wages, benefits, rules, regulations and the conditions of my employment at any time.
I acknowledge that I may be offered employment subject to a medical examination and/or questionnaire, and that such examination and/or questionnaire could nullify my ultimate employment by this employer. I agree to submit to any such medical examination and/or questionnaire.

Signature of Applicant
Date

Please print the form before submitting. Then sign the printed copy and bring to the interview.