Application Today's Date * MM DD YYYY Name * First Name Last Name Preferred Name/Nickname Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone * (###) ### #### Alternate Phone (###) ### #### Email * Schedule and Pay Are you interested in: Full Time Part Time Temporary What schedule would you prefer? Weekdays Weekends Evenings Nights How did you hear about the position? Desired Pay * Hourly Pay (Minimum, if applicable) Annual Pay * Minimum Annual Pay * Desired When are you able to start work? * MM DD YYYY In what local area do you prefer to work? * Position Desired Work Authorization Are you authorized to work in the United States? * Federal law requires that employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with these laws, JoePro Xpress will verify the status of every individual offered employment with the Company. In this connection, all offers of employment are subject to verification of the applicant's identity and employment authorization, and it will be necessary for you to submit such documents as are required by law to verify your identification and employment authorization. Yes No Are you under 18 years of age? * JoePro Xpress is an equal opportunity employer and does not discriminate against any applicant or employee because of race, color, religion, sex, national origin, disability, age, or military or veteran status in accordance with federal law. In addition, JoePro Xpress complies with applicable state and local laws governing non-discrimination in employment in every jurisdiction in which it maintains facilities. JoePro Xpress also provides reasonable accommodation to qualified individuals with disabilities in accordance with applicable laws. Yes No Are you capable of performing the essential functions of the job for which you are applying with or without a reasonable accommodation? Yes No Work Experience PLEASE LIST YOUR WORK EXPERIENCE BELOW (MOST RECENT JOB FIRST) Company Name * Your Position and Title * Supervisor's Name, Title, and Position Supervisor's Telephone Number (###) ### #### Employed From * Month/Year Employed To * Month/Year Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Type of Business * Termination * Voluntary Involuntary Reason * Briefly describe your major duties and reason(s) for termination * Company 2 Compamy Name Your Position and Title Supervisor's Name, Title, and Position Supervisor's Telephone Number (###) ### #### Employed From Month/Year Employed To Month/Year Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Type of Business Termination Voluntary Involuntary Reason Briefly describe your major duties and reason(s) for termination Company 3 Company Name Your Position and Title Supervisor's Name, Title, and Position Supervisor's Telephone Number (###) ### #### Employed From Month/Year Employed To Month/Year Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Type of Business Termination Voluntary Invoulntary Reason Briefly describe your major duties and reason(s) for termination Education Name and Address of School * High School or Prep Major Subject Did you graduate? * Yes No Type of Degree or Diploma Name and Address of School College Major Subject Did you graduate? Yes No Type of Degree or Diploma Line Name and Address of School Other Major Subject Did you graduate? Yes No Type of Degree or Diploma Professional Designations Designation Organization Granting Designation Date Completed MM DD YYYY Designation Organization Granting Designation Date Completed MM DD YYYY Professional Licenses Type of License State Granting License License Number Type of License State Granting License License Number References Please list three professional references Name * First Name Last Name Relationship * Company * Phone / Alternate Phone * Name * First Name Last Name Relationship * Company * Phone / Alternate Phone * Name * First Name Last Name Relationship * Company * Phone / Alternate Phone * I have submitted the attached form to the company for the purpose of obtaining employment. I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate the company to further process my application. My signature below attests to the fact that the information that I have provided on my application, resume, given verbally, or provided in any other materials, is true and complete to the best of my knowledge and also constitutes authority to verify any and all information submitted on this application. I understand that any misrepresentation or omission of any fact in my application, resume or any other materials, or during any interviews, can be justification for refusal of employment, or, if employed , termination from the Company's employ. I also affirm that I have not signed any kind of restrictive document creating any obligation to any former employer that would restrict my acceptance of employment with the Company in the position I am seeking. I understand that this application is not an employment contract for any specific length of time between the Company and me, and that in the event I am hired, my employment will be "at will" and either the Company or I can terminate my employment with or without cause and with or without notice at any time. Nothing contained in any handbook, manual, policy and the like, distributed by the Company to its employees is intended to or can create an employment contract, an offer of employment or any obligation on the Company's part. The Company may, at its sole discretion, hold in abeyance or revoke, amend or modify, abridge or change any benefit, policy practice, condition or process affecting its employees. References: I hereby authorize the company and its agents to make such investigations and inquiries into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquires connected with my application and I specifically authorize the release of information by any schools, businesses, individuals, services or other entities listed by me in this form. Furthermore, I authorize the company and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications. Temporary/Contract Employment: If employed as a temporary or contract employee, I understand that I may be an employee of the company and not of any client. If employed, I further understand that my employment is not guaranteed for any specific time and may be terminated at any time for any reason. I further understand that a contract will exist between the company and each client to whom I may be assigned which will require the client to pay a fee to the company in the event that I accept direct employment with the client, I agree to notify the company immediately should I be offered direct employment by a client (or by referral of the client to any subsidiary or affiliated company), either for a permanent, temporary (including assignments through another agency), or consulting positions during my assignment or after my assignment has ended. Type Name for Digital Signature * First Name Last Name Date Submitted MM DD YYYY Thank you!
