EmailMe Form - Capanna Application

Tell us who you are.

Name *

First Last

Current Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Permanent Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone *

### - ### - ####

Email

Are you 18 or older? *

Yes, I am.

No, I am not.

If younger than 18 how old are you?

You and Capanna

Reference

Know someone who works at Capanna or someone really famous? Or just, who told you to apply?

Which store are you applying for? *

Downtown Iowa City

North Liberty

Position Desired *

Date you can start *

MM / DD / YYYY

Salary Desired *

Have you applied here before?

If so where?

Downtown Iowa City

North Liberty

Old Coralville Location

When did you apply previously

MM / DD / YYYY

Hours of Availability: *

example:
Monday: open to close
Tuesday: 10am - 3pm
Wed - Sun: n/a

Number of Hours Requested: *

Lets talk about your past.

Are you currently employed? *

Yes, & you may contact them.

Yes, but please do not contact them

No, I am not.

Did you attended High School? *

Where?
When?
Did you Graduate?

Did you attended College/Trade School? *

Where?
When?
How Long?
Area of Study?
Did you Graduate?

Have you served in the US MIlitary or Naval Services?

What was your rank?

Former Employer #1 *

Name:
Address:
Salary:
Dates worked:
Position:
Reason for leaving:

Former Employer #2

Name:
Address:
Salary:
Dates worked:
Position:
Reason for leaving:

Former Employer #3

Name:
Address:
Salary:
Dates worked:
Position:
Reason for leaving:

List 3 Contacts:
Name, Phone #
Occupation
Years known *

example:
Marty Mcfly: 555-555-5555, Time Traveler, 5 years.
Cade Skywalker: 555-555-5556, Jedi, 4 years.
Geordi Laforge: 555-555-5557, Engineer, 3 years.

Full Name: *

By Typing your name above and submitting this form you are making the following claim:

“ I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”