Juice Junkies Application

Juice Junkies Application
Full Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Last 4 of SSN*
If hired, can you furnish proof you are eligible to work in the U.S.?*

YesNo
Are you at least 18 years of age or older?*

YesNo
Have you or anyone you know ever worked at Juice Junkies before?*

YesNo
If yes, when & where

Employment History Information
Work History: Current and previous 2 employers (most current employer listed first)
Most Recent Employer Name

First NameLast Name
City, State
Position Held
Start Date

MonthDayYear
Date Finished

MonthDayYear
Employer phone

Area CodePhone Number
Supervisor name

First NameLast Name
Describe your duties:
Reason for leaving
NEXT EMPLOYER
Employer Name

First NameLast Name
City, State
Position Held
Start Date

MonthDayYear
Date Finished

MonthDayYear
Employer phone

Area CodePhone Number
Supervisor name

First NameLast Name
Describe your duties:
Reason for leaving
NEXT EMPLOYER
Employer Name

First NameLast Name
City, State
Position Held
Start date

MonthDayYear
Date Finished

MonthDayYear
Employer phone

Area CodePhone Number
Supervisor name

First NameLast Name
Describe your duties:
Reason for leaving

Additional Information
Have you ever been convicted of a felony?*

YesNo
If yes, please give date and explain
Have you ever been employed under a name other than the name used on this application?*

YesNo
If yes, please explain

EDUCATION INFORMATION
HIGH SCHOOL
Name & City/State of High School*
Course of Study/ Degree Earned*
Did you graduate?*

YesNoAttending
COLLEGE OR UNIVERSITY
Name & City/State of College or University
Course of Study/ Degree Earned
Did you graduate?

YesNoAttending
OTHER
Name & City/State of OTHER (specify)
Course of Study/ Degree Earned
Did you graduate?

YesNoAttending
You should hire me because...*
Resume

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I understand and agree that, if hired my employment is "at will" and is not for a definate period and may, regardless of circumstances, be terminated at any time without prior notice by the Company. I further acknowledge that no contract of employment will be valid against the company unless signed by the Chief Operating Officer of the Company.

I acknowledge that as a condition of my employment, I will be required to agree to be bound by the terms of and sign the Company. Failure to sign this Agreement shall result in revocation of my offer of employment.
Choose ONE:*

I ACCEPTI DO NOT accept
Date*

MonthDayYear
Signature*

First NameLast Name
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