Request edit access
Lucky Ones Coffee Application
A coffee shop that employs and empowers individuals with disabilities
Participants Full Name *
Participant (or Legal Guardian) Email *
Participant (or Legal Guardian) Phone Number *
Date of Birth *
Highest Level of Education Completed *
School you are currently enrolled in?
Do you have your own transportation or reliable way of getting to and from work? *
Have you ever been employed or received job training before? *
Who referred you to this program? *
Relationship to this person (if they are with an employment agency what agency do they work for) *
Contact Information for the person who referred you (Email and Phone Number)
What length of shifts are you comfortable working? *
What days of the week are you available to work? *
What Position are you most interested in working? *
How do you best feel supported? *
What would you say are your two biggest strengths? *
What are the two biggest areas you would like to improve?
What goals do you have for working at Lucky Ones Coffee?
Please Rate on the Following Scale
1= No interest/skill in this area
2= Slight interest/skill in this area
3= Moderate interest/skill in this area
4= High interest/skill in this area
5= Extremely high interest/skill in this area
Comfort working around noise *
Greeting customers in a positive manner
Clear selection
Following basic instructions from a supervisor
Clear selection
Serving and making hot beverages
Clear selection
Helping to take in and track inventory
Clear selection
Entering a customers order into a computer
Clear selection
Answering customers questions and giving recommendations
Clear selection
Taking on leadership
Clear selection
Doing dishes and mopping
Clear selection
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy