Jack & Jill Center Application for Employment "*" indicates required fields We appreciate your interest in Jack & Jill Center. Jack & Jill Center is an equal employment opportunity employer. Jack & Jill Center's policy is not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age, past or present military service, disability, genetic information, or any other basis protected by applicable federal, state, or local laws. Jack & Jill Center also prohibits harassment of applicants or employees based on any of these protected categories. It is also Jack & Jill Center’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions. GENERAL INFORMATIONPlease complete all requested information. Today's Date* MM slash DD slash YYYY Position Applying For*Name* Last First Middle Minimum Salary Desired*Date Available for Work* DD slash MM slash YYYY Are you at least 18 years old?* Yes No Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone (Personal)*Telephone (Work)Email* Have you previously worked for or applied for a position with Jack & Jill Center, in any of our locations either as an employee or through an employment agency?* Yes No If yes, please explain when and, if employed, in what capacity:Are you related to or in a close personal relationship with anyone now employed at Jack & Jill Center? (An answer of “Yes” will not automatically disqualify you from the position for which you are applying.)* Yes No If yes, state name(s) and where they are located.Are you available to work overtime as needed?* Yes No If Yes, when are you available? Weekdays weekends PERMISSION TO WORKAre you legally authorized to work in the United States?* Yes No Will you now or in the future require sponsorship for employment visa status (e.g. H-1B status)?* Yes No REFERRAL INFORMATIONHow did you learn about us?* Referral (state name below) Employment Agency (state name below) School (state name below) LinkedIn Indeed Jack & Jill "Careers" page Other (explain below) WORK EXPERIENCEPlease specify your complete full-time and part-time employment history, including self-employment. Begin with your most recent employer. If you require additional space, please use the space belowCompany Name*Address* Street Address City State / Province / Region ZIP / Postal Code Name, Title and Phone Number of Supervisor*Supervisor Phone*Supervisor Email* Employment Start Date* MM slash DD slash YYYY Are you still employed here?* Yes No Employment End Date MM slash DD slash YYYY Begining Monthly Salary*Ending Monthly SalaryJob Title and Work Responsibilities*Reason for Leaving*Company #2 NameAddress Street Address City State / Province / Region ZIP / Postal Code Name and Title of SupervisorSupervisor PhoneSupervisor Email Employment Start Date MM slash DD slash YYYY Employment End Date MM slash DD slash YYYY Begining Monthly SalaryEnding Monthly SalaryJob Title and Work ResponsibilitiesReason for LeavingPlease list any additional Work Experience here:All employers including your current employer may be contacted to verify the information you provide. May we contact your current employer prior to any offer of employment?* Yes No PROFESSIONAL REFERENCESIndividuals not related to you. Business references preferred.Reference 1 Name*Occupation*Phone*Address* Street Address City State / Province / Region ZIP / Postal Code Years Known and Capacity*Reference 2 Name*Occupation*Phone*Address* Street Address City State / Province / Region ZIP / Postal Code Years Known and Capacity*EDUCATION & TRAININGHigh School or Last Grade CompletedName & Location of School*Number of Years Completed*TwelveElevenTenNineEightSevenSixFiveFourThreeTwoOneCourse of Study*Degree/Diploma*CollegeName & Location of SchoolNumber of Years CompletedFourThreeTwoOneDegree/DiplomaCourse of StudyGraduate SchoolName & Location of SchoolNumber of Years CompletedFourThreeTwoOneDegree/DiplomaCourse of StudyBusiness, Trade, Techinical SchoolName & Location of SchoolNumber of Years CompletedFourThreeTwoOneDegree/DiplomaCourse of StudyJOB RELATED SKILLS & QUALIFICATIONSPlease summarize your job-related skills and qualifications:*Files - Please upload a cover letter & resume,* Drop files here or Select files Accepted file types: pdf, jpg, png, doc, xls, xlsx, docx, Max. file size: 10 MB. APPLICANT'S STATEMENT & ACKNOWLEDGMENTTHIS APPLICATION IS NOT COMPLETE UNTIL IT IS FULLY COMPLETED, SIGNED, AND ALL STATEMENTS BELOW HAVE BEEN READ AND INITIALED1.* I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered. 2.* I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause or notice. I understand that only the Owner of Jack & Jill Center, and no manager, supervisor, or other representative of the Company, has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the at-will employment relationship, and with respect to any agreement entered into by the Owner, any such agreements must be in writing and signed by the Owner and by me or my authorized representative. 3.* I further understand and agree that, except for my at-will employment status, if hired, my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by Jack & Jill Center. 4.* I understand that Jack & Jill Center may share the information contained in this application with other Jack & Jill Center employees for employment and administrative purposes and hereby consent to such transfer. 5.* I hereby authorize, to the extent allowed by applicable federal state and local laws, Jack & Jill Center to conduct its own investigation of my references, employment history and education and, further, authorize the references and prior employers I have listed to disclose to Jack & Jill Center information related to my employment history and qualifications for the position for which I am applying, without giving me prior notice of such disclosure. 6.* I understand and expressly agree that if employed by Jack & Jill Center, storage areas provided for me (locker, desk, etc.) are open to investigation by Jack & Jill Center without prior notice to me. My signature below certifies that I agree to be bound by the terms and conditions stated in this application, which contains all the understandings between the Company and me concerning the topics addressed herein, and supersedes any prior inconsistent understandings between the Company and me on such issues.Full Name of Applicant*Date Signed* MM slash DD slash YYYY This application will only be considered for 30 days. If you have not been hired within 30 days of submitting this application and you wish to continue to be considered for employment, you must complete another application.NameThis field is for validation purposes and should be left unchanged.
