I would be interested in working at the store location: (select all that apply)
To select multiple stores, hold down the Ctrl key when selecting additional stores
Keva Juice #1 at Cutler & San MateoKeva Juice #2 at Academy & WyomingKeva Juice # 3 at CottonwoodKeva Juice #4 at Juan Tabo & MenaulKeva Juice # 5 On MontanoKeva Juice #6 on University in Las CrucesKeva Juice #7 at Paseo & WyomingKeva Juice #8 at Downtown PlazaKeva Juice #9 at Wyoming south of MenaulKeva Juice #10 UNMKeva Juice #11 Relocating!Keva Juice #12 off 550 in BernalilloKeva Juice #13 Riverside at Coors & MontanoKeva Juice #14 at Cottonwood Mall

Name: Date Of Birth: / /
Telephone: Email Address:
Address:

Name:
Address:
Telephone: Relationship:

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
From
To

*Our hours of operation are generally 7 a.m. to 10 p.m.

Date You Can Start Working: / /
Total Hours per Week:

	Name	City	State	G.P.A	Last Grade Completed	Graduated/GED
High School						Yes No
Alternative School						Yes No
College						Yes No
Other						Yes No

Company:	Address:
Position:	Supervisor:
Wage:	Dates Worked:
Reason for Leaving:

Company:	Address:
Position:	Supervisor:
Wage:	Dates Worked:
Reason for Leaving:

Company:	Address:
Position:	Supervisor:
Wage:	Dates Worked:
Reason for Leaving:

Have you ever been asked to leave a job by an employer? Yes No
If YES, please explain:

Three references please, using no more than 1 family member

	Name	Relationship	Phone Number	Address
1.
2.
3.

1. Are you at least 16 years of age?	Yes No
2. Do you have legal right to work in the U.S.?	Yes No
3. Do you have reliable transportation?	Yes No
4. Have you been convicted of a criminal offense?	Yes No
5. If YES on question 4, please explain:

What do you like to do in your spare time?


How would others describe you?


Have you ever visited a Keva Juice Location? Describe your experience.


Why do you want to work at Keva Juice?


What are your strengths that would make you an asset to the Keva Tribe?