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Application for Employment

    Applicant Information

    Your Full Name

    Present Address

    Permanent Address (if different from present address)

    Employment Desired

    Personal Information

    Have you ever applied to or worked for Cuppa Tahoe before?

    Employment Application

    If hired, would you have reliable means of transportation to and from work?
    Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum age.)
    Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable acccommodations?

    (note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, skill, and agility tests.)

    We may refuse to hire relatives of present employees if doing so could result in actual or potential problems in supervision, security, safety, or morale, or if doing so could create conflicts of interest.

    Education, Training, and Experience

    High School

    Did you Graduate?


    Did you Graduate?


    Did you Graduate?

    Health Care Training

    Did you Graduate?

    Employment History

    List below all present and past employment starting with your most recent employer (last five years sufficient).

    Employer 1

    Dates of Employment
    May we contact this employer for reference?

    Employer 2

    Dates of Employment
    May we contact this employer for reference?


    List below three persons not related to you who have knowledge of your work performance within the last three years.

    Reference 1

    Reference 2

    Reference 3

    Please Read Carefully, Check Each Paragraph and Sign Below

    Cuppa Tahoe will consider qualified applicants, including those with criminal histories, in a manner consistent with the state and local "Fair Chance" laws.