Work @ Local Groundz Want to work at the newest coffee shop in LaGrange? Apply below! Personal Information First Name Middle Last Name Address City State Zip Home Phone Mobile Phone Email Address Employment Desired Position Date You Can Start Desired Salary Are you legally authorized to work in the U.S.? Education High School City, State From: To: Did You Graduate? Diploma College City, State From: To: Did You Graduate? Diploma References Please list two professional references. Full Name Relationship Company Phone/Email Full Name Relationship Company Phone/Email Previous Employment Company Phone Address Supervisor Job Title Responsibilities From To Reason for Leaving? May we contact this supervisor for a reference?YesNo Company Phone Address Supervisor Job Title Responsibilities From To Reason for Leaving? May we contact this supervisor for a reference?YesNo Company Phone Address Supervisor Job Title Responsibilities From To Reason for Leaving? May we contact this supervisor for a reference?YesNo Disclaimer I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. YesNo