First Name *

First Name

Last Name *

Last Name

Preferred Name *

Preferred Name

Pronouns *

Pronouns (she/her, he/him, they/them)

Phone Number *

Phone Number

Email Address *

Email Address

Date available to start *

Date available to start

How many days/hours can you work? *

How many days/hours can you work?

Are there any days of the week or times you cannot work?

Are you available on weekends? *

Are you available on weekends?

Do you have any time off or vacations planned? *

Do you have any time off or vacations planned?

Name of Previous Employer *

Name of Previous Employer

Phone Number of Previous Employer *

Phone Number of Previous Employer

Email of Previous Employer *

Email of Previous Employer

Please include 2 references (not relatives)

Name of Reference 1 *

Name of Reference 1

Relationship to Reference 1 *

Relationship to Reference 1

Phone Number of Reference 1 *

Phone Number of Reference 1

Email of Reference 1 *

Email of Reference 1

Name of Reference 2 *

Name of Reference 1

Relationship to Reference 1 *

Relationship to Reference 1

Phone Number of Reference 2 *

Phone Number of Reference 2

Email of Reference 2 *

Email of Reference 2

Tell us about yourself, why you’d like to work at Grocer’s Daughter Chocolate, and what makes you a good candidate for this position.

Personal Statement

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Application for Part-Time Year-Round Retail Member.

Chocolate Covered Coffee Beans