Coffee Doodle Doo - Application for Barista

Stein Oil Co., Inc. is an equal opportunity Employer.

The conditions of employment are stated at the end of this form. Please read carefully before you sign.

Location Applying At: __________________________________ Date of Application: ______/_______/_______________

Are you willing to work at another location different from where you have applied? Yes No

Personal Information

Name: ________________________________________________________________________ Telephone #: (_________)___________-________________

First Middle Last
(Current)
Address:_____________________________________________________________________ ___________________
Street City State Zip Code Length of time at address
(Previous)
Address:_____________________________________________________________________ ___________________
Street City State Zip Code Length of time at address

If you are under 18 years old, please give your birthdate: / / How did you hear about Stein Oil Co., Inc.?
Have you ever worked for Stein Oil Co., Inc. before? Yes No If yes, where?
Approximate Date: Reason for leaving:

General Information

Date Available to Start: _____/_____/_________ Wage Expected: $_____._____ Part Time Full Time

Please fill in hours you are available to work below:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Education

Years Attended Graduated?

Name of School City, State
(Circle One) (Circle One)
High School: 1 2 3 4 Yes No GED
College: 1 2 3 4 Yes No
Degrees/Certificates Earned: Do you have a food handler’s card? Yes No

Employment History
Please list your present or most recent job, along with two previous jobs, starting with the most current.

Name of Company Address City, State

Present or
Last Employer:

Starting Date: / / Leaving Date: / / Starting Wage: $ . Ending Wage: $ .

Job Title: Description of Work:

Reason for leaving: Explain periods between jobs:

May we contact your last employer? Yes No Name of Supervisor: Phone #: ( ) -
 Name of Company Address City, State
Present or
Last Employer:

Starting Date: / / Leaving Date: / / Starting Wage: $ . Ending Wage: $ .

Job Title: Description of Work:

Reason for leaving: Explain periods between jobs:

May we contact your last employer? Yes No Name of Supervisor: Phone #: ( ) -
Name of Company Address City, State
Present or
Last Employer:

Starting Date: / / Leaving Date: / / Starting Wage: $ . Ending Wage: $ .

Job Title: Description of Work:

Reason for leaving: Explain periods between jobs:

May we contact your last employer? Yes No Name of Supervisor: Phone #: ( ) -
Supplemental Information

Why would you like to work as a Barista?

Describe your own approach to exemplary customer service within a café setting.

Describe a situation where you had to work with several different personality types.

How would you deal with an employee who is not doing their fair share of the work?

What did you like best about your last job?

What did you like least about your last job?

In the past year, what personal or professional accomplishment are you most proud of?

Think of a manager or supervisor you have had in the past. Which one did you like best and why?

Are you authorized to accept employment in the United States?  Yes  No

(Successful applicants will be required to prove identity and eligibility for employment.)

Is any additional information relative to change of name, use of assumed name, preferred name, or nickname necessary to verify the information on
this application? If yes, please list the information:

If you are under the age of 18, can you provide proof of age and/or work permit?  Yes No  Not Applicable

Attendance and Punctuality Information

Consistent attendance and punctuality are essential requirements of every job with Stein Oil Co., Inc. Is there anything which would interfere with
your regular attendance and punctuality if offered a job with us?  Yes  No
If yes, please explain:______________________________________________________________________________________________________
Is there any aspect of the of the job function which you are applying for that you cannot perform or may need accommodations to perform?
 Emergency Contact Information
Name Home Address Home Phone #

( ) -
Relationship Work Address Work Phone #

( ) -
Notification and Agreement

Please read before signing:

I certify the facts and information on this application are true and complete to the best of my knowledge. I understand any falsification,
misrepresentation, as well as any misleading statements or omissions on this application (or any other accompanying or supporting documents) will
result in denial of employment or immediate termination of employment, regardless of when or how discovered.

Questions regarding this statement need to be directed to any employment interviewer before signing. The application will be given every
consideration but its receipt does not imply the applicant will be employed.

It is the policy of Stein Oil Co., Inc. to afford equal opportunity to all associated and applicants for employment without regard to age, race, religion,
gender, national origin, veterans, and individuals with a qualified disability. Your eligibility for the position which you are applying will be
considered with this in mind.

I authorize the investigation of all matters which the company deems relevant to my qualifications for employment, including all statements made in
this application and in any attachments or supporting documents. I authorize you to request and receive such information and I release from all
liability any persons (such as former supervisor) or employers supplying it. I also release you from the liability which might result from making the
investigation.

I understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between Stein
Oil Co., Inc. or myself for either employment or the providing of any benefit. I understand an agree if I am offered and accept a position, my
employment may be terminated, with or without cause, and with or without notice, at any time at the discretion of either the Company or myself. I
also agree to conform to all existing and future company rules and regulations and I understand the employer reserves the right to change wage,
hours, and working conditions as deemed necessary.

I understand and agree that if I am hired the statements in this paragraph will become a binding part of my employment relationship. I have read each
of these statements and have also reviewed all of the information provided on this application.

I authorize Stein Oil Co., Inc. to make a complete investigation of all statements contained on my application.

Signature:________________________ _________ Date:______/______/___________

13001 Clackamas River Dr. #200

Oregon City, OR 97045
503.656.0375
 AUTHORIZATION FOR RELEASE

_________________________________________________ _____________________
Print Full Name (First, Middle, Last) Date of Birth

__________________________________ _________________________ ________

Social Security Number Driver’s License Number State

I voluntarily and knowingly authorize any present employer or supervisor, past employer or supervisor, college,
university or other institution of learning, administrator, law enforcement agency, state agency, federal agency, private
business or the National Personnel Records Center, personal references and/or other persons, to give records of
information they may have concerning my criminal history, and employment records or any other information
requested to Stein Oil Co., Inc. This authorization shall be valid for one-year from the date signed and a photographic or
faxed copy of the authorization shall be valid as the original.

As a part of our normal procedure for processing applications an investigative consumer report may be obtained. This
report typically includes information on an applicant’s character, general reputation, personal characteristics, and mode
of living. Further information on the nature and scope of such a report, if one is obtained, is available to you upon
written request.

According to the FAIR CREDIT REPORTING ACT, I am entitled to know if employment is denied from a Consumer
Reporting Agency. I will be so advised and be given the name of the agency or source information.

______________________________________ ____________________
Signature Date