Jumpin' Jacks Employment Application

Applicant Data

Date
Position applied for:
How did you find us:
****First name:
Middle name:
Last name:
Address:
City:
Zip:
****Phone	- -
Cell	- -

If you are under 18 can you furnish a work permit?	Yes No N/A
Are you a citizen of the United States?	Yes No
If not, do you have work papers?	Yes No
Do you have a truck or van?	Yes No
Do you have a driver's license	Yes No
Do you have Insurance?	Yes No
Have you ever pled "guilty" or "no contest" to or been convicted of a crime?	Yes No
If yes, give dates and details	Type details here:

Answering yes to these questions does not constitute an automatic rejection to employment. Date of the offense, seriousness and nature of the violation rehabilitation and position applied for will be considered.

Education

High School
City
Did you graduate?	Yes No

College/University
City
Did you graduate?	Yes No

Other
City
Did you graduate?	Yes No

References

Please furnish the names, address and telephone numbers of two people to whom you are not related and by whom you have not been employed:

1) Name
Address:
City:
Zip:
Phone	- -

2) Name
Address:
City:
Zip:
Phone	- -

Previous employment (begin with most recent position):

No experience necessary, training is provided.

2) Next previous employer
1) Date of Employment from:	/ /
To:	/ /
Position(s) held:
Company name:
Company address:
Company city:
Company state:
Company zip:
Phone:	- -
Supervisor:
Starting salary:
Ending salary:
Responsibilities:	Please enter here.
Reason for leaving:	Please enter here.
May we contact this employer for reference?	Yes No




Date of Employment from:	/ /
To:	/ /
Position(s) held:
Company name:
Company address:
Company city:
Company state:
Company zip:
Phone:	- -
Supervisor:
Starting salary:
Ending salary:
Responsibilities:	Please enter here.
Reason for leaving:	Please enter here.
May we contact this employer for reference?	Yes No

Special skills or qualifications:

Summarize your skills	Please enter here.

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Application will be signed at interview

Signature of Applicant_________________________________________ Date_________________

**** Required fields