APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status, citizenship, union membership, creed, familial status, status with regards to public assistance, and memberships in local human rights commission or any other protected Federal, State or Local status unrelated to the performance of the work involved.
Positions Applying For
Date of Application

MonthDayYear
Date
How Did You Learn About Us Please check one and note the source
Name

First NameMiddle NameLast Name
Address
City
State
Zip
Telephone Number*
Email
example@example.com
Are you 18 years old or 19 years old or older? (Must be 19 years or older to drive company vehicles*
Do you have a current, valid driver's license? If yes, Select # of violations 1 major violation or 2 or more minor violations/at fault accidents in past 3 years
Have you ever filed an application with us before?
Have you ever been employed with us before?
If Yes, select date

MonthDayYear
Date
Do any of your friends or relatives work at J and J Holmes? If yes, state name, relationship and location. If yes, state name, relationship and location.
Are you currently employed?
May we contact your present employer?
Are you legally authorized to work in the United States?
If you are legally authorized to work in the United States? Will you now or in the future be required sponsorship for employment visa status (i.e. H-1B visa status) ?
Date available for work

MonthDayYear
Date
What is your desired salary range
Enter Desired Hourly Wage or Desired Yearly Salary
Select ALL Available shifts you are Available to work

Full Time AMFull Time PMFull Time Over NightsPart Time AMPart Time PMPart Time Over Nights
Can you travel if the job requires it?
Education:

Please Complete your Education Profiles
High School Name & Address
High School Course of Study
High School Years Completed
High School Diploma / Degree
Undergraduate College Name & Address
Undergraduate College Course of Study
Undergraduate College Years Completed
Undergraduate College Diploma / Degree
Graduate / Professional Name & Address
Graduate / Professional Course of Study
Graduate / Professional Years Completed
Graduate / Professional Diploma / Degree
Other (Specify) Name & Address
Other Course of Study
Other Years Completed
Other Diploma / Degree
WORK EXPERIENCE:

(Do not write "See Resume") Please list your work history, including the military, starting with your most recent employer.
Work History 01 Employer Name
Work History 01 Employer Address
Work History 01 Employer Phone Number
Please enter a valid phone number.
Work History 01 Starting / Present Job Title
Work History 01 Supervisor Name
Work History 01 Reason for Leaving
Work History 01 Work Performed
Work History 01 Start Date

MonthDayYear
Date
Work History 01 End Date

MonthDayYear
Date
Work History 01 May we Contact this Employer?
Work History 02 Employer Name
Work History 02 Employer Address
Work History 02 Employer Phone Number
Please enter a valid phone number.
Work History 02 Starting / Present Job Title
Work History 02 Supervisor Name
Work History 02 Reason for Leaving
Work History 02 Work Performed
Work History 02 Start Date

MonthDayYear
Date
Work History 02 End Date

MonthDayYear
Date
Work History 02 May we Contact this Employer?
Work History 03 Employer Name
Work History 03 Employer Address
Work History 03 Employer Phone Number
Please enter a valid phone number.
Work History 03 Starting / Present Job Title
Work History 03 Supervisor Name
Work History 03 Reason for Leaving
Work History 03 Work Performed
Work History 03 Start Date

MonthDayYear
Date
Work History 03 End Date

MonthDayYear
Date
Work History 03 May we Contact this Employer?
Describe any specialized training apprenticeship skills and extra curricular activities.
You may exclude membership which would reveal gender race religion national origin age ancestry disability or other protected status
Describe any job related training received in the United States military
List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status
ADDITIONAL INFORMATION
Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience.
State any additional information you feel may be helpful to us in considering your application
SPECIALIZED SKILLS (skills / equipment operated)
PERSONAL/PROFESSIONAL REFERENCES

Name

Phone #

OccupationEmail

other
PERSONAL/PROFESSIONAL REFERENCES

Name

Phone #

OccupationEmail

other
PERSONAL/PROFESSIONAL REFERENCES

Name

Phone #

OccupationEmail

other
APPLICANT'S STATEMENT
I certify that the answers given herein are true and complete. I authorize an investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

Ihereby understand and acknowledge that, unless otherwise defined by applicable law, any

employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I authorize J and J Holmes, Inc. to investigate my current or previous employment and academic experience/qualifications. This information may include, but is not limited to, academic, achievement, performance, attendance, and disciplinary records. I hereby request you to release such information upon the request of J and J Holmes, Inc. I understand that the information released is for official use by J and J Holmes,

I hereby release any individual, employer, or institution, including record custodians, from any and all liability for damages of whatever kind or nature which may at any time result to me on account of compliance, or any attempts to comply with this authorization.
Printed Name of Applicant
Signature of Applicant

Clear
2125 Troop Drive Sartell, MN 56377 Phone: 320.230.2708 www.jandjholmes.cominfo@jandjholmes.com

APPLICATION FOR EMPLOYMENT

Education:

WORK EXPERIENCE:

APPLICANT'S STATEMENT