Jump Around VA
Application for Employment
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Email *
Name *
Last, First, Middle
Date of Application *
Present Address *
Telephone *
Use the Following Format: 555-555-5555
Position applied for *
Salary desired *
How much you want to get paid per hour
What is your age? (drivers have to be a minimum age for insurance reasons)
Do you have any driving violations? please describe
Days available *
Required
How many hours can you work weekly? *
Have you ever been convicted of a crime? *
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.
skills experience *
Please check any skills you have experience in
Required
References *
Please list two references with phone #'s other than relatives or friends (References are people we can call to ask about your work ethic and behavior)
What is your means of transportation to work? *
How Will You Get To Work? Parent/Bus/Your Own
Work Experience *
Please provide a list of work experience from most recent to least recent for the last 5 years or so.  Please include employer,  title, skills used and reason for leaving.
Do you have any physical limitations? if so, please explain. *
Are you able to lift 75 pounds or more? *
Have you ever had to file for workman’s comp or been injured on the job? *
Are you willing to do a background check, drug test and driving check? *
Any accidents or tickets in the past 5 years? *
Do you own a smartphone that can be used for GPS navigation and phone calls while working?
Clear selection
Are you a citizen of the United States our authorized to work in the U.S.? *
May we contact your current employer? *
Did you complete this application yourself? *
Can you work holidays? *
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