Date of Application
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MM
DD
YYYY
Name
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First, Middle and Last
First Name
Last Name
Email
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Phone
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(###)
###
####
Location's Interested In
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How many hours per week are you looking for?
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Hours Preferred
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(early mornings, mornings,
afternoons, late afternoons, evenings)
Date You Can Start
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MM
DD
YYYY
Current Employer
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Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Are You Still Working Here?
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Position Held
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Supervisor Name/Contact Person
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Phone
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(###)
###
####
May We Contact Your Employer?
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Reason for Leaving
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Duties or Responsibilities at Previous Job
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Did You Complete High School?
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Name of High School
*
Did you attend college, graduate school, vocational school, correspondence school or military school? Please include information below:
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School
Major
Years Completed
Degree or certificate received
1. Have you held jobs which required waiting on customers?
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2. Do you like dealing with the public?
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3. Have you had any experience at cashier work?
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4. Have you had to count money in your work?
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5. Have you used a cash register before?
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6. Have you ever worked in a convenience store or gas station?
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Activities
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List all hobbies & activities you are currently involved in (e.g., softball, speech, bowling). All our positions generally require evening and weekend shifts.
Have you worked for Jack's before?
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If you have worked for Jack's, when and where?
Did someone refer you?
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I certify that all the information submitted by me on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my application will be rejected, and if I am employed, my employment can be terminated at any time. In consideration of my employment, I agree to conform to the company’s rules and regulations and agree that the company can terminate me without notice my employment and compensation at any time. In the event that I resign, I agree to give my employer two (2) weeks’ notice of termination.
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By typing your name in the box below, you affirm that you have read and understood the information provided in this submission form. By doing so, you acknowledge that the information you have provided is true and accurate to the best of your knowledge and belief. This electronic signature serves as your legal and binding agreement to the authenticity of the submitted information, and any intentional misrepresentation may result in legal consequences.
Today's Date
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MM
DD
YYYY
