Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

FT/PT *

Full Time

Part Time

Temp/Seasonal

Emergency contact

First Name

Last Name

Emergency contact phone

(###)

###

####

Were you referred by anyone?

First Name

Last Name

Are you over 18? *

Yes

No

Have you ever worked for our company before? *

Yes

No

Have you ever been convicted of a felony?

yes

no

Days Available to Work

Please indicate the days you are available to work. Refer to our operation hours to know specific times of day we are open. Usually 10a-6p.

Mon

Tues

Wed

Thur

Fri

Sat

Sun

Today's Date

please enter today's date

MM

DD

YYYY

AT WILL STATEMENT *

We make no representation regarding the nature or duration of employment at consciousfork or conscious habitat. All employment is "at will." That means that, if hired, either you or consciousfork or conscious habitat may terminate the employment relationship at any time, with or without cause, subject to all relevant laws.

Agree

Disagree

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand false or misleading information that I provide in my application or during the interview process may result in the termination of employment.

Agree

Disagree