TEAM MEMBER - CORPORATE LOCATION



APPLICATION FOR EMPLOYMENT

DATE OF APPLICATION


Independently Owned & Operated Franchise Location
__________________


An Equal Opportunity Employer



It is the Company's policy to provide equal opportunity in conformance with all applicable state and federal laws.

All questions must be answered and the application must be signed and dated.


PERSONAL
NAME (LAST, FIRST, MIDDLE)


SOCIAL SECURITY NUMBER
TELEPHONE NUMBER (HOME)
ADDRESS (CITY, STATE, ZIP CODE )


TELEPHONE NUMBER (OTHER)
PLEASE INDICATE ANY OTHER NAMES YOU HAVE USED WHILE WORKING OR ATTENDING SCHOOL, SUCH AS A FORMER NAME, ETC.


ARE YOU UNDER 18 YEARS OF AGE?
YES NO

IF REQUIRED, CAN YOU PROVIDE A VALID WORK PERMIT?
YES NO

Minors will not be permitted to work unless they are legally able to do so under all applicable
state and federal laws. A minor may only be permitted to work in accordance with the terms,
restrictions and limitations set forth in their work permit, if one is required.

EMPLOYMENT DESIRED
POSITION DESIRED:


PAY EXPECTED:
LOCATION(S) PREFERRED:
HOW DID YOU LEARN ABOUT HIS OPPORTUNITY?
DATE YOU ARE AVAILABLE FOR EMPLOYMENT:


ARE YOU AVAILABLE TO WORK ON:

WEEKENDS? YES NO HOLIDAYS? YES NO

AVAILABILITY

HOURS AVAILABLE SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY
FRIDAY
SATURDAY TOTAL HOURS AVAILABLE PER WEEK:

FROM



WOULD
YOU
WORK:

FULL TIME PART TIME

TO



SHIFTS
PREFERRED:

DAYS NIGHTS WEEKENDS

ARE YOU WILLING TO WORK OVERTIME WHEN AND AS REQUIRED? YES NO

GENERAL INFORMATION
HAVE YOU EVER APPLIED FOR EMPLOYMENT OR WORKED FOR GLORIA JEANS COFFEES
OR ONE OF ITS FRANCHISE LOCATIONS?

YES NO

IF YES, WHEN & WHERE:
WHAT WAS YOUR SUPERVISORS NAME?


REASON FOR LEAVING:
DO YOU HAVE ANY FRIENDS OR RELATIVES EMPLOYED BY GLORIA JEANS COFFEES?

YES NO
IF YES, NAME & LOCATION:

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR SERIOUS MISDEMEANOR? YES NO

IF YES, STATE NATURE OF CRIME(S), WHEN AND WHERE CONVICTED AND DISPOSITION OF THE CASE. CA LOCATIONS - CONVICTIONS FOR MARIJUANA
RELATED OFFENSES MORE THAN 2 YEARS OLD NEED NOT BE DISCLOSED:


*NOTE: No applicant will be denied employment solely on the basis of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding
circustances and the relevance of the offense to the position(s) applied for, however, may be considered.
ARE YOU ABLE TO PERFORM ALL OF THE ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING, WITH OR WITHOUT A REASONABLE
ACCOMMODATION? YES NO

IF NECESSARY, PLEASE DESCRIBE THE TYPE(S) OF REASONABLE ACCOMMODATIONS THAT ARE NEEDED?


HAVE YOU EVER BEEN COUNSELED FOR CASH HANDLING SITUATIONS (OVER/SHORT), CUSTOMER SERVICE ISSUES OR INABILITY TO MEET/ADHERE TO
COMPANY STANDARDS? YES NO

IF YES, PLEASE EXPLAIN:


EDUCATIONAL HISTORY

SCHOOL
NAME & LOCATION
COURSE OF STUDY
LEVEL OR YEARS
COMPLETED
TYPE OF DEGREE OR CERTIFICATE
HIGH
SCHOOL




COLLEGE/
OTHER




ARE YOU GOING TO SCHOOL NOW? YES NO DAY CLASSES NIGHT CLASSES IDENTIFICATION REQUIREMENTS


CAN YOU SUBMIT VERIFICATION OF YOUR LEGAL RIGHT TO WORK IN THE UNITED STATES? YES NO


YOU WILL BE REQUIRED TO PROVIDE NECESSARY PROOF OF YOUR ELIGIBILITY AND LEGAL AUTHORIZATION TO WORK IN THE UNITED STATES AS
PROVIDED UNDER THE IMMIGRATION REFORM AND CONTROL ACT OF 1986 (IRCA). PLEASE REFER TO THE LISTS OF ACCEPTABLE DOCUMENTS TO
ESTABLISH WHICH DOCUMENTS YOU MAY PRESENT, AFTER HIRED, TO ESTABLISH YOUR IDENTITY AND LEGAL AUTHORITY TO WORK IN THE U.S.


EMPLOYMENT HISTORY
PLEASE READ CAREFULLY: BEGIN WITH PRESENT OR MOST RECENT EMPLOYER AND LIST ALL JOBS YOU HAVE HELD FOR THE PAST FIVE YEARS.
ACCOUNT FOR ALL PERIODS OF UNEMPLOYMENT IN THE SPACE PROVIDED.


FROM: TO:


LAST OR PRESENT EMPLOYERS NAME AND COMPLETE ADDRESS
STARTING WAGE

$ PER
ENDING WAGE

$ PER
YOUR JOB TITLE
SUPERVISORS NAME
TELEPHONE NO.
DESCRIPTION OF DUTIES


REASON FOR LEAVING

MAY WE CONTACT THIS EMPLOYER? YES NO


FROM: TO:


EMPLOYERS NAME AND COMPLETE ADDRESS
STARTING WAGE

$ PER
ENDING WAGE

$ PER
YOUR JOB TITLE
SUPERVISORS NAME
TELEPHONE NO.
DESCRIPTION OF DUTIES


REASON FOR LEAVING

MAY WE CONTACT THIS EMPLOYER? YES NO


FROM: TO:


EMPLOYERS NAME AND COMPLETE ADDRESS
STARTING WAGE

$ PER
ENDING WAGE

$ PER
YOUR JOB TITLE
SUPERVISORS NAME
TELEPHONE NO.
DESCRIPTION OF DUTIES


REASON FOR LEAVING

MAY WE CONTACT THIS EMPLOYER? YES NO



PLEASE EXPLAIN ANY PERIODS OF UNEMPLOYMENT:


FROM: ______________________ TO: _______________________ HOW DID YOU SPEND THIS TIME?


FROM: ______________________ TO: _______________________ HOW DID YOU SPEND THIS TIME?


DRUG AND ALCOHOL POLICY

GLORIA JEANS COFFEES HAS A VITAL INTEREST IN MAINTAINING A DRUG AND ALCOHOL FREE ENVIRONMENT FOR ITS EMPLOYEES. CUSTOMERS AND
VISITORS. THE COMPANY PROHIBITS THE USE OF, POSSESSION OF. DISTRIBUTION OF, PURCHASE OR SALE OF, OFFERING TO PURCHASE OR SELL,
TRANSFER OR TRAFFICKING IN AND WORKING OR REPORTING FOR WORK UNDER THE INFLUENCE OF INTOXICANTS, DRUGS OR CONTROLLED OR ILLEGAL
SUBSTANCES.


PLEASE READ AND SIGN BELOW

I HEREBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION FORM IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND
AGREE TO HAVE ANY OF THE STATEMENTS CHECKED BY GLORIA JEANS COFFEES, I VOLUNTARILY AND KNOWINGLY AUTHORIZE ANY PRESENT OR
PAST EMPLOYER OR SUPERVISOR; COLLEGE OR UNIVERSITY OR OTHER INSTITUTION OF LEARNING; ADMINISTRATOR; LAW ENFORCEMENT
AGENCY, STATE AGENCY, LOCAL AGENCY, FEDERAL AGENCY, PRIVATE BUSINESS, MILITARY BRANCH OR THE NATIONAL PERSONNEL RECORDS
CENTER, PERSONAL REFERENCE AND/OR ANY OTHER PERSONS TO GIVE RECORDS OR INFORMATION THEY MAY HAVE CONCERNING MY CRIMINAL
HISTORY, MOTOR VEHICLE HISTORY, SOCIAL SECURITY NUMBER, EARNINGS HISTORY, CHARACTER, AND EMPLOYMENT (INCLUDING REASONS FOR
TERMINATION) OR ANY OTHER INFORMATION REQUESTED BY GLORIA JEANS COFFEES. FURTHER, I RELEASE ALL PARTIES AND PERSONS FROM
ANY AND ALL LIABILITY FOR ANY DAMAGES THAT MAY RESULT FROM FURNISHING SUCH INFORMATION TO THE COMPANY AS WELL AS FROM THE USE
OR DISCLOSURE OF SUCH INFORMATION BY THE COMPANY OR ANY OF ITS AGENTS, EMPLOYEES, OR REPRESENTATIVES.

I UNDERSTAND THAT ANY MISREPRESENTATION, FALSIFICATION, OR MATERIAL OMISSION OF INFORMATION ON THIS APPLICATION MAY RESULT IN MY
FAILURE TO RECEIVE AN OFFER OR, IF I AM HIRED, IN MY IMMEDIATE DISMISSAL FROM THE COMPANY. IN CONSIDERATION OF MY EMPLOYMENT, I
AGREE TO CONFORM TO THE RULES AND STANDARDS OF THE COMPANY AND I ACKNOWLEDGE THAT MY EMPLOYMENT AT GLORIA JEANS COFFEES
IS FOR NO DEFINITE PERIOD OF TIME AND THAT THIS NOTHING IN THIS APPLICATION SHALL CONSTITUTE A CONTRACT OF EMPLOYMENT OR
GUARANTEE OF EMPLOYMENT. I AGREE THAT MY EMPLOYMENT IS AT-WILL MEANING THE TERMS OF EMPLOYMENT MAY BE CHANGED AT ANY TIME,
FOR ANY REASON, WITH OR WITHOUT NOTICE AND WITH OR WITHOUT CAUSE, EITHER AT MY OPTION OR AT THE OPTION OF THE COMPANY. THIS
INCLUDES BUT IS NOT LIMITED TO: TERMINATION, DEMOTION, PROMOTION, TRANSFER, COMPENSATION, BENEFITS, DUTIES, AND LOCATION OF
WORK. MY STATUS AS AN AT-WILL EMPLOYEE CANNOT BE CHANGED.

FURTHER, I UNDERSTAND THAT ALL OFFERS OF EMPLOYMENT ARE CONDITIONED ON THE RECEIPT OF SATISFACTORY RESPONSES TO REFERENCE
REQUESTS, SATISFACTORY PROOF OF AN APPLICANTS IDENTITY AND LEGA