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As an EQUAL EMPLOYMENT OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER, Perk Place Cafe does not discriminate against applicants or employees because of their age, race, color, sexual orientation, religion, national origin, gender (except where gender is a bona-fide occupational qualification) or on any other basis prohibited by law. Furthermore, Perk Place Cafe will not discriminate against any applicant or employee because he or she is mentally or physically disabled, a disabled veteran, or a veteran of the Vietnam era, provided he or she is qualified and meets the requirements established by Perk Place Cafe for the job.

Date *

First Name *

Last Name *

Email *

Phone *

Address *

Zip Code *

Are you at least 18 years old? *

Yes

No

Availability to work? *

Full Time

Part Time

Temporary

What position are you applying for? *

Current Pay Rate | Desired Pay Rate | Minimum Pay Rate *

Have you ever been convicted of a Felony? *

Yes

No

High School

High School Name

Address

City

State

Zip Code

Years Attended

Did you graduate?

Yes

No

College

College Name

Address

City

State

Zip Code

Years Attended

Did you graduate?

Yes

No

What degree did you recieve?

References (Name(s) and Contact Information)

Previous Employment (Name(s) and Contact Information)

Military Service

Branch

From

To

Resume or any other information you may want to add *

Disclaimer and Signature

Signature *

Date *

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. *

Yes

Submit