Personal Data
Full Name:
Address:
City:		State:	Zip Code:
Home Phone:		Work Phone:
Fax:		Email: (Must be correct)

Educational Background (please list schools attended, years attended and grade of degree attained):

Profession (Current employer / years):

Dates	Company	Position	Nature of Business
Any other business in which you are an owner, partner or officer?
May we contact you at work? Yes, best time to call:     No

Personal Background Information:
Have you ever visited a Port City Java® Cafe? Yes No    If yes, where?
Have you worked for Port City Java® or any of our franchisees? Yes No    If yes, where?
Why would you like to be a Port City Java® Cafe employee?
At which Port City Java® Cafe do you seek employment?
1st choice:
2nd choice:
3rd choice:

References:
Personal:
Name	Title	Address	Phone
Other comments:

I understand that the granting of employment is at the sole discretion of the particular Port City Java® store management. I have read this Employment Application and everything I have stated in it is true. Additionally, I understand that the information provided by me will be relied upon by the employer.