Employment Application

Employment Requested

Days Available to Work:

Hours Available for Work:


Criminal Background




Disclosure and Release

By submitting this application, I understand that: All information I provide is subject to a thorough review and confirmation by Lost Coffee and Human Resources; and I may be disqualified for employment if Lost Coffee determines that I have provided any deliberately false, misleading, inaccurate, incomplete or knowingly untruthful answers to any question(s). If selected for an in-office interview, I will be asked to affirm this electronic signature with an actual signature. I hereby certify that all of the foregoing information I have provided is accurate and true to the best of my knowledge.