Application Form

Applicant Information

First Name   MI

Last Name

Street Address   Apartment/Unit

City   State   Zip

Phone #

Email

Emergency Contact

Emergency Phone Number

Date Available   Desired Salary

Position Applied For

How did you learn of this opening?


Have you ever worked at JLR&CS? YesNo

If so, when?


Education

High School

Name

Address

Did you graduate? YesNo

Degree


College

Name

Address

Did you graduate? YesNo

Degree


Other

Name

Address

Did you graduate? YesNo

Degree


Employment History

Current Employer - if not currently employed leave this section blank

Company

Address   Phone

Job Title   Supervisor

Starting Salary   Ending Salary

Responsibilities

From   To: Present

Reason for leaving


Previous Employment

Company

Address   Phone

Job Title   Supervisor

Starting Salary   Ending Salary

Responsibilities

From   To

Reason for leaving

May we contact your supervisor for a reference? YesNo


Previous Employment 2

Company

Address   Phone

Job Title   Supervisor

Starting Salary   Ending Salary

Responsibilities

From   To

Reason for leaving

May we contact your supervisor for a reference? YesNo


Previous Employment 3

Company

Address   Phone

Job Title   Supervisor

Starting Salary   Ending Salary

Responsibilities

From   To

Reason for leaving

May we contact your supervisor for a reference? YesNo


Previous Employment 4

Company

Address   Phone

Job Title   Supervisor

Starting Salary   Ending Salary

Responsibilities

From   To

Reason for leaving

May we contact your supervisor for a reference? YesNo


Have you ever been discharged or asked to resign? YesNo If yes, please explain.


Professional Organization Membership

Honors received, volunteer or community service, or other organizations you have participated in which are related to the position for which you are applying:


U.S. Armed Forces Experience

Were you in the U.S. Armed Forces? YesNo

If yes, which branch?

Rank at discharge

If your former employment references, education or military service are under a name other than indicated on the front of the application, please indicate below:

Last

First   MI


Availability Record

Please fill in the times of the individual days of your availability to work. Fill in the time under From and To, and click on the according a.m. and p.m. for that time.

Sunday   From   To

Monday   From   To

Tuesday   From   To

Wednesday   From   To

Thursday   From   To

Friday   From   To

Saturday   From  To

Are you available to work:
Weekends? YesNo
Holidays? YesNo
Rotating Shifts? YesNo

I understand that emergency conditions may require me to temporarily work shifts other than the one for which I am applying and agree to such scheduling changes as directed by my director or manager or Executive Director of JLR&CS or his/her designee.

By checking this box and typing my name below, I am electronically signing my application. I understand and agree that my electronic signature executed in conjunction with the electronic submission of my application will be legally binding and such transaction will be considered authorized by me.

Full Name


Employment Understanding

Equal Employment Opportunity
This Company is dedicated to providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, ancestry, national origin, citizenship status, age, pregnancy, handicap or disability, genetic information or condition, sexual orientation, gender identity or expression, military status or status as a veteran, in accordance to applicable laws. In addition, the Company complies with applicable state and local laws governing nondiscrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation benefits, and training.

Truth
I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that the Company is relying on my complete honesty. I understand that any inaccuracy, misrepresentation, or incomplete answer provided by me in this application will cancel the application or may result in termination if I have been employed.

Investigation
I understand that, as a condition of employment, the Company must conduct and receive favorable results of a thorough pre-employment investigation, and periodic investigations throughout employment. These investigations include, but may not be limited to, current employer reference checks, former employer reference checks, personal reference checks, criminal record checks, drug testing, credit bureau reports, financial institution account verification checks, physical examinations, investigation and review of all internet and web postings and comments made by me, and a review of my driving record if I am applying for a position that involves driving.

I hereby authorize the Company to conduct these investigations to obtain any requested information, and to update this information, and to investigate all statements made by me in this application. I hereby direct former employers, all references, individuals, and all applicable government agencies to respond to the Company’s questions concerning my application for employment. I understand that the information released or provided is for business use by the Company and may be disclosed to third parties as necessary in the conduct of its business. If I am hired, I authorize the Company to supply my employment record, in whole or in part, to any prospective employer, government agency, or other party with a legal and proper interest. I release the Company, these parties and any individual, including record custodians, from any and all liability for any damage that may result from furnishing the requested information or any of my personal records.

I am not subject to a covenant-not-to-compete agreement, or any other work restricting agreement. I agree to indemnify and hold the Company harmless for any damages and legal expenses in the event that this representation and warranty is or becomes false. I agree not to use any confidential or proprietary information from prior employment in my employment with the Company and agree not to disclose any information I am contractually or otherwise legally bound to keep confidential.

Employment At Will
I understand that if I am employed by the Company, I will be an employee at will. My employment can be terminated at any time by me or the Company, with or without notice, and with or without reason, in accordance with the Laws of the State of Ohio. The terms and conditions of my employment, my compensation, and my benefits may be changed at any time by the Company. Any oral statements or promises to the contrary are not binding on the Company. If hired, I will comply with all rules and regulations of the Company.

I have read and agree with the information contained in Employment Understanding above.

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