Boardman Jumpstart Java Employment Application

Full Name*

First NameMiddle NameLast Name

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

example@example.com

Phone Number*

Format: (000) 000-0000.

Position Applied*

Available Start Date*

Do you have documentation proving your legal authorization to work in the United States?*

Do you have a food handlers card?*

How did you hear about us*

1. Please list a reference that is not related to you.*

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

2. Please list a reference that is not related to you.*

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

3. Please list a reference that is not related to you.*

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Morning (between 5:00am-11:00am)Afternoon (between 11:00am-3:00pm)Evening (between 3:00pm- 7:00pm)

SaturdaySunday

Morning (between 6:00am-10:00am)Afternoon (between 10:00am-2:00pm)Evening (between 2:00pm- 6:00pm)

Most Recent Employer (If this is your first job, please notate "First Job" below)*

Position Held

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Supervisor

Dates of employment from blanks to blank

Job Description:

Reason for Leaving:

Previous Employer

Position Held

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Supervisor

Dates of employment from blanks to blank

Job Description:

Reason for Leaving:

Previous Employer

Position Held

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Supervisor

Dates of employment from blanks to blank

Job Description:

Reason for Leaving:

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PLEASE READ THE FOLLOWING STATEMENT CAREFULLY BEFORE SUBMITTING THIS APPLICATION. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT,
PLEASE ASK THEM BEFORE SUBMITTING.

I hereby certify that the information contained in this application is true and correct and without omission, and agree to have any of the statements checked by Boardman Jumpstart Java unless I have indicated to the contrary. I authorize the
references listed above to provide Boardman Jumpstart Java any and all information concerning my previous employment and any pertinent information that they may have. Further, I release all parties and persons from any and all
liability for any damages that may result from furnishing such information to Boardman Jumpstart Java as well as from the use or disclosure of such information by Boardman Jumpstart Java or any of its agents, employees or representatives.
I understand that any misrepresentation, falsification or material omission of the information on this application may result in my failure to receive an offer or, if I am hired, in my dismissal from employment.

In consideration of my employment, I agree to conform to the rules and standards of Boardman Jumpstart Java and agree that my employment can be terminated at any time. I understand that no employee or representative of Boardman
Jumpstart Java other than the owner 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. I also understand that all offers of employment are
conditioned on the provision of satisfactory proof of an applicant’s identity and legal authority to work in the United States. I understand that my employment may be subject to the satisfactory results of any pre-employment examinations
required including testing for illegal drugs.

Job Application