Employment Form

Please complete the entire employment application and submit electronically below. All * fields are required.

First, Middle Name *

Last Name *

Other names you are known by?

Email Address *

Social Security *

Are you less than 18 years of age? *

Are you legally ellgible for employment in the U.S.? *
(All new hires will be required to provide proof of ellgibility to work in the U.S.)

Have you been convicted of a crime in the last seven (7) years? *


(If Yes, list convictions that are a matter of public record [arrests are not convictions]. A conviction will not necessarily disqualify you for emplyment.)

Present Street Address *

City *

State *

Zip Code*

Home Phone Number *

Mobile Phone Number *

Position Applying For *

Location Applying For *

Sunday (Availability)

Monday (Availability)

Tuesday (Availability)

Wednesday (Availability)

Thursday (Availability)

Friday (Availability)

Saturday (Availability)

Are you available to work overtime?

Have you ever worked for Dripp, Inc.?

If Yes, where?

High School Name and Address:

Select Last Years Completed:
1234

Did You Graduate?
YesNo

Subjects Studied and Degrees Received:

College Name and Address:

Select Last Years Completed:
1234

Did You Graduate?
YesNo

Subjects Studied and Degrees Received:

Post College, Trade, Business or Correspondence School Name and Address:

Select Last Years Completed:

Did You Graduate?

Subjects Studied and Degrees Received:

List skills relevant to the position applied for:

Typing Skills WPM:

Have you ever visited a Dripp location? Where? Describe your experience.

What do you like about coffee and the ice cream sandwich?

Why would you like to work for Dripp, Inc.? *

Describe a specific situation where you have provided excellent customer service in your most recent position. Why was this effective? *

Current Employer Name and Address 1:

Type of Business:

From:

To:

Starting Rate:

Ending Rate:

If hourly, average # of hours per week?

Position:

Reason For Leaving:

Duties Performed:

Supervisor's Name:

Supervisor's Phone Number:

May We Contact?

Current Employer Name and Address 2:

Type of Business:

From:

To:

Starting Rate:

Ending Rate:

If hourly, average # of hours per week?

Position:

Reason For Leaving:

Duties Performed:

Supervisor's Name:

Supervisor's Phone Number:

May We Contact?

Current Employer Name and Address 3:

Type of Business:

From:

To:

Starting Rate:

Ending Rate:

If hourly, average # of hours per week?

Position:

Reason For Leaving:

Duties Performed:

Supervisor's Name:

Supervisor's Phone Number:

May We Contact?

References Name 1:

Address:

Phone Number:

Business In:

Years Acquainted:

How Do You Know This Person?

References Name 2:

Address:

Phone Number:

Business In:

Years Acquainted:

How Do You Know This Person?

References Name 3:

Address:

Phone Number:

Business In:

Years Acquainted:

How Do You Know This Person?

Emergency Contact Name:

Emergency Contact Phone Number:

If you have a resume you would like to include, please attach and submit with your application.

I hereby authorize Dripp, Inc. to thoroughly investigate my background, references, employment record and other matters related to my suitability for employment. I authorize persons, schools, my current employer (if applicable), and previous employers and organizations contacted by Dripp, Inc. to provide any relevant information regarding my current and/or previous employment and I release all persons, schools, employers of any and all claims for providing such information. I understand that misrepresentation or omission of facts may result in rejection of this application, or if hired, discipline up to and including dismissal. I understand that I may be required to sign a confidentiality and/or non-compete agreement, should I become an employee of Dripp, Inc. I understand that nothing contained in this application, or conveyed during any interview which may be granted, is intended to create an employment contract. I understand that filling out this form does not indicate there is a position open and does not obligate Dripp, Inc. to hire me. (U.S. APPLICANTS ONLY: I understand and agree that my employment is at will, which means that it is for no specified period and may be terminated by me or Dripp, Inc. at any time without prior notice for any reason. MARYLAND APPLICANTS ONLY: Under Maryland law, an employer may not require or demand, as a condition of employment, prospective employment, or continued employment, that an individual submit to or take, a lie detector or similar test. An employer who violates this law is guilty of misdemeanor and subject to a fine not exceeding $100. MASSACHUSETTS APPLICANTS ONLY: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. CALIFORNIA APPLICANTS ONLY: Applicant may omit any convictions for the possession of marijuana (except for convictions for the possessions of marijuana on school grounds or possession of concentrated cannabis) that are more than two(2) years old, and any information concerning a referral to, and participation in, any pretrial or post trial diversion program.

DATE: *
(By typing the Date, You agree that this is legal and valid as your signature.)

DIGITAL SIGNATURE: *
(By typing your Name, You agree that this is legal and valid as your signature.)

WE ARE AN EQUAL OPPORTUNITY EMPLOYER COMMITTED TO HIRING A DIVERSE WORKFORCE.

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