top of page

Blue Rock Coffee Company

Job Application Form

GENERAL INFORMATION

Birthday
Month
Day
Year
Position
Start Date
Month
Day
Year

i.e. Going back to school, going home for the summer, moving, getting married, etc.

PERSONAL INFORMATION

Are you a U.S. Citizen or approved to work in the United States?
Yes
No
Do you have any condition which would require job accommodations?
Yes
No

Blue Rock Coffee Company complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.

Have you ever been convicted of a criminal offense (felony or misdemeanor)?
Yes
No

No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

JOB SKILLS / QUALIFICATIONS

EDUCATION

Are you a member of the Armed Service?
Yes
No

PREVIOUS EMPLOYMENT #1

PREVIOUS EMPLOYMENT #2

REFERENCES

ADDITIONAL INFORMATION

RESUME

AT-WILL EMPLOYMENT

The relationship between you and the Blue Rock Coffee Company is referred to as "employment at will". This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or Blue Rock Coffee Company. No representative of Blue Rock Coffee Company has the authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at-will", and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and our Company's President.

APPLICANT SIGNATURE

By typing your name below you are certifying that the information contained in this application is correct to the best of your knowledge and that you understand that falsification of this information is grounds for a refusal to hire, or if hired, dismissal.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
bottom of page