Last Name


First Name


Middle Name

Current Address

Phone #


Email Address

Emergency Contact Name


Emergency Contact Phone #

Position Applied For:

Preferred Location(s) (you may select multiple locations):
Sunriver, ORBend, OR63rd, WAOrchards, WAHazel Dell, WAFisher's Landing, WARidgefield, WA

1. Is there any information we would need about your name or use of another name for us to be able to check your work record?
(If so, please list alternate names. Otherwise leave blank or enter "NO".):

2. Do you have any relatives who are presently (or who have formerly been) employed by Brewed Awakenings?
(If so, please list their names. Otherwise leave blank or enter "NO".)

3. How were you referred to Brewed Awakenings?

4. Have you ever been convicted of a felony? YesNo
If yes, please explain:

5. Do you have any objection to a drug-screening test if hired? YesNo

(please do not list former employers.)

• 1. Personal Reference

  
  Name
  
  Occupation
  
  Years Known
  
  Telephone
  

• 2. Personal Reference

  
  Name
  
  Occupation
  
  Years Known
  
  Telephone
  

• 3. Personal Reference

  
  Name
  
  Occupation
  
  Years Known
  
  Telephone
  

1. If your application receives favorable consideration, when will you be available to begin work?

2. Do you have any objection to working overtime? YesNo

3. Can you work overtime without prior notice? YesNo

4. Can you work on Saturday? YesNo

5. Can you work on Sunday? YesNo

6. preferred shift(s):
MorningsAfternoonsEvenings

7. Please list specific hours or days you cannot work:

8. Do you have transportation to get to work? YesNo

9. If your application receives favorable consideration, what rate of pay would you require?

• High School

  
  
  School Name/Location
  
  
  Years Completed
  
  
  Degree/Diploma
  
  

• College

  
  
  School Name/Location
  
  
  Years Completed
  
  
  Degree/Diploma
  
  

• Tech Training

  
  
  School Name/Location
  
  
  Years Completed
  
  
  Degree/Diploma
  
  

• Other

  
  
  School Name/Location
  
  
  Years Completed
  
  
  Degree/Diploma
  
  

• 1. Current/Most Recent Employer

  
  Company Name
  
  
  Position Held
  
  

  
  Address
  
  
  Telephone
  
  
  Dates Employed
  
  

  
  Manager/Supervisor
  
  
  Wage/Salary
  
  
  Reason for Leaving
  
  

• 2. Previous Employer

  
  Company Name
  
  
  Position Held
  
  

  
  Address
  
  
  Telephone
  
  
  Dates Employed
  
  

  
  Manager/Supervisor
  
  
  Wage/Salary
  
  
  Reason for Leaving
  
  

• 3. Previous Employer

  
  3. Company Name
  
  
  Position Held
  
  

  
  Address
  
  
  Telephone
  
  
  Dates Employed
  
  

  
  Manager/Supervisor
  
  
  Wage/Salary
  
  
  Reason for Leaving