Submit an Application Step 1 of 4 25% Name First Middle Initial Last Current Address Street Address City State / Province / Region ZIP / Postal Code Home PhoneCell PhoneEmail address Are you legally eligible to work in the United States? Yes No Do you have a valid Driver's License?Select Option...YesNoDo you have a reliable source of transportation?Select Option...YesNoIf "Yes" what type? List the tools you currently havePosition applying for Desired salary Type of employment Full Time Part Time Full Time or Part Time What days and time are you available to work? Education (High School)Name of School Diploma? Yes No Address Street Address City State / Province / Region Work related skills and experienceEducation (Business or Trade School)Name of School Name of Program Diploma? Yes No Address Street Address City State / Province / Region Work related skills and experienceEducation (Community College)Name of School Name of Program Diploma? Yes No Address Street Address City State / Province / Region Work related skills and experienceEducation (University)Name of School Name of Program Diploma? Yes No Address Street Address City State / Province / Region Work related skills and experience Employment HistoryPlease list your jobs in reverse chronological order (most recent job first)Name Of Employer Job Title Name of Supervisor Phone numberHourly Wage/Salary Period of Employment From MM slash DD slash YYYY To MM slash DD slash YYYY Address Street Address City State / Province / Region Reason For LeavingResponsibilitiesName Of Employer Job Title Name of Supervisor Phone numberHourly Wage/Salary Period of Employment From MM slash DD slash YYYY To MM slash DD slash YYYY Address Street Address City State / Province / Region Reason For LeavingResponsibilitiesName Of Employer Job Title Name of Supervisor Phone numberHourly Wage/Salary Period of Employment From MM slash DD slash YYYY To MM slash DD slash YYYY Address Street Address City State / Province / Region Reason For LeavingResponsibilities Background CheckHave you ever been convicted of a felony?(Required) Yes No If Yes, please explainWhen you sign this application, your signature will give JC Smith LLC permission to perform a background check on your criminal history. Given the litigation climate and potential employer liability for workers’ actions, JC Smith must review criminal records with consideration of whether the record is job-related. The background check use constitutes a business necessity. It is a discriminatory disparate impact on groups protected under Title VII of the Civil Rights Act.ReferencesFor employment references, may we contact:Your current / most recent employer? Yes No Your previous employers? Yes No Please list other references herePlease include Name, Phone Number, and your relationship with referenceSignatureI understand that a false statement man disqualify me from employment of be grounds for dismissalSignature(Required) Please type your nameDate MM slash DD slash YYYY
