Jumpin' Jimmy's On-line Job Application
 
 Applicant Information      
First Name:
*		 Middle Name:
 Last Name:
*		  
Address:
*		 City:
*		 State:
*		 Zip Code:
*
Telephone:
*		 Mobile/Beeper/Other phone:
 E-mail Address:
  
Position you are applying for: *
Referral Source: (select the source and provide a description)
* Description: *
 General Questions      
If necessary, the best time to call you at home is:
May we contact you at work?  Yes  No    Work Phone Number:     Best time to call:
If you are under 18 and it is required, can you furnish a work permit?    Yes   No 
 

If no, please explain:  

Have you submitted an application here before?      Yes   No  *

If yes, please give date(s) and position(s):  

Have you ever been employed by Jumpin Jimmy's before?      Yes   No  *

If yes, please provide dates:   

Are you legally eligible for employment in this country?      Yes   No  *
Date you would be available to start work:  * Type of employment desired: *
What is your desired salary range or hourly rate of pay?    $  per  *
Will you relocate if job requires it?      Yes   No  * Will you travel if job requires it?      Yes   No  *
If they have been explained to you, are you able to meet the attendance requirements of the position?      Yes   No  *
Will you work overtime if required?    Yes   No  *    If no, please explain:
Please provide your drivers license number if driving may be required in position for which you are applying:
       State:        Have you ever been bonded?   Yes   No
Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Have you ever pled "guilty" or "no contest" to, or been convicted of a felony?      Yes   No  *
 

If yes, please provide date(s) and details:    

 Employment History      
Starting with your most recent (or current) employer, please provide the following information.
Recent Employer 1
Name of Employer:
 Address:
 City:
 State:
Telephone:
 Your starting job title:
 Your final job title:
  
Dates employed:  From   to   
Starting pay:
 Final pay:
 Commission/Bonus/Other compensation:
Name of Immediate supervisor and title:
 May we contact this person for reference?    Yes   No
Why did you leave?
 Summarize the type of work performed and responsibilities:
What did you like most about your position?
 What were the things you liked least about the position?
Recent Employer 2    If no more former employers to enter, skip down to Other Employment Information section.
Name of Employer:
 Address:
 City:
 State:
Telephone:
 Your starting job title:
 Your final job title:
  
Dates employed:  From   to   
Starting pay:
 Final pay:
 Commission/Bonus/Other compensation:
Name of Immediate supervisor and title:
 May we contact this person for reference?    Yes   No
Why did you leave?
 Summarize the type of work performed and responsibilities:
What did you like most about your position?
 What were the things you liked least about the position?
Recent Employer 3    If no more former employers to enter, skip down to Other Employment Information section.
Name of Employer:
 Address:
 City:
 State:
Telephone:
 Your starting job title:
 Your final job title:
  
Dates employed:  From   to   
Starting pay:
 Final pay:
 Commission/Bonus/Other compensation:
Name of Immediate supervisor and title:
 May we contact this person for reference?    Yes   No
Why did you leave?
 Summarize the type of work performed and responsibilities:
What did you like most about your position?
 What were the things you liked least about the position?
Other Employment Information
Explain any gaps in your employment, other than those due to personal illness, injury or disability:
 If not addressed previously, have you ever been fired or
asked to resign from a job?  If yes, please explain:
 Skills and Qualifications      
Summarize any special training, skills, licenses and/or certificates that may assist you in the position for which you are applying:
Computer Skills  (check appropriate circles. Include software titles and years of experience.)
Word Processing software Titles: Years of experience:  
Spreadsheet software Titles: Years of experience:  
Presentation software Titles: Years of experience:  
E-mail software Titles: Years of experience:  
Internet software Titles: Years of experience:  
List other software titles in which you have experience or other computer skills:
 Educational Background      
Starting with your most recent school attended, provide the following information.
School Name: (include City and State)
 Years completed:
 GPA/Class Rank:
Describe Degrees and/or Certifications attained, if applicable:
 List Majors and Minors, if applicable:
School Name: (include City and State)
 Years completed:
 GPA/Class Rank:
Describe Degrees and/or Certifications attained, if applicable:
 List Majors and Minors, if applicable:
School Name: (include City and State)
 Years completed:
 GPA/Class Rank:
Describe Degrees and/or Certifications attained, if applicable:
 List Majors and Minors, if applicable:
 References      
List name and telephone number of three business/work references who are not related to you and are not previous supervisors.
If not applicable, list three school or personal references who are not related to you.
Name:
 Relationship to you:
 Telephone Number:
 Years known:
Name:
 Relationship to you:
 Telephone Number:
 Years known:
Name:
 Relationship to you:
 Telephone Number:
 Years known:
 Related Information      
To what job-related organizations (professional, trade, etc.) do you belong?  Exclude memberships that would
reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national
guard or any other similarly protected status.
List special accomplishments, publications, awards, etc.  Exclude information that would reveal race, color, religion,
sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly
protected status.
In your current or a prior job, have you ever written instructions to be followed by employees or customers?
Yes   No    Not Applicable

If yes, please explain:
Is there any other job-related information you want us to know about you?
       
That's it!  Just click the Submit button, and the information will be routed to the appropriate personnel!