QJ Application

Name:

First NameLast Name
Phone Number:

Area CodePhone Number
E-mail Address:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Available Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If you are applying for a seasonal position, please include your "end date"

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you 21yrs of age or older
Position(s) Applying for: (Select all that interest you)

What is your availability?

Rows	Available	Unavailable
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

How many days per week do you wish to work at Queen Jayne's?
Please submit your resume
Upload Resume:

Upload a File

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Work Experience
Current or Most Recent Employer
Company or Employer Name
Name of your Direct Report

First NameLast Name
Phone Number

Area CodePhone Number
Date Started

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Ended

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Describe your duties/salary:
Reason for leaving:
May we contact this employer?
#2 Employer Name & Phone Number
Company or Employer Name
Name of your Direct Report

First NameLast Name
Phone Number

Area CodePhone Number
Date Started

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Ended

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Describe your duties/salary:
Reason for leaving:
May we contact this employer?
#3 Employer Name & Phone Number
Company or Employer Name
Name of your Direct Report

First NameLast Name
Phone Number

Area CodePhone Number
Date Started

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Ended

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Describe your duties/salary:
Reason for leaving:
May we contact this employer?
Education: please circle your highest level of education
Certifications/Titles: select any that you have obtained