EMPLOYMENT APPLICATION
Jackrabbit Java
781 N. Jackrabbit Trail
Buckeye, AZ 85326
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Email *
PERSONAL INFORMATION
NAME (First, Middle, Last) *
PRESENT ADDRESS *
PHONE NUMBER *
Are you 15 years or older? *
Are you a U.S. Citizen or an alien authorized to work in the United States? *
Are you looking for full time or part time work? *
How many hours per week are you looking to work? *
EDUCATION
What is the highest level of education you have completed? *
High School (Name, Location, # of years attended, subjects studied) *
Did you graduate? *
College (Name, Location, # of years attended, subjects studied)
Did you graduate?
Clear selection
Trade, Business or Correspondence School (Name, Location, # of years attended, subjects studied)
Did you graduate?
Clear selection
EMPLOYMENT
Are you currently employed? *
Most Recent Employer (Name, Location, Dates employed, Salary, Position, Reason for leaving)
Employer (Name, Location, Dates employed, Salary, Position, Reason for leaving)
Employer (Name, Location, Dates employed, Salary, Position, Reason for leaving)
REFERENCES
Please provide one personal and one professional reference
Personal Reference (Name, Phone Number, Relationship, Years Acquainted) *
Professional Reference (Name, Phone Number, Business, Years Acquainted) *
PHYSICAL RECORD
(Note: Jackrabbit Java complies with the ADA and considers reasonable accommodation measures that
may be necessary for eligible applicants/employees to perform essential functions. )

Do you have any condition which would require job accommodations? (If yes, please list below) *
Accommodations required
If you would like to include a resume, please email it to jackrabbitjavaco@gmail.com after submitting your application.
AT-WILL EMPLOYMENT
The relationship between you and the Jackrabbit Java is referred to as "employment at will." This
means that your employment can be terminated at any time for any reason, with or without cause, with
or without notice, by you or the Jackrabbit Java. No representative of Jackrabbit Java has authority to
enter into any agreement contrary to the foregoing "employment at will" relationship. You understand
that your employment is "at will," and that you acknowledge that no oral or written statements or
representations regarding your employment can alter your at-will employment status, except for a written
statement signed by you and either our Executive Vice-President/Chief Operations Officer or the
Company's President.
SIGNATURE *
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