JX Enterprises, Inc. Application for Employment

Applicant Information
Date:  Pick a date
*Last Name: *First Name: *MI:
Previous Name (if any):   Change Date: Pick a date
*Street Address:
*City: *State: *Zip Code:
*Home Phone: (555-555-1234)
Email: *Location Preference:
Position Applying for: List Position of Interest:
Salary Requirements: (20,000/15.50)     Annual Hourly
If hired, when would you be available to start? Pick a date
*How were you referred to our company? Explain:
*Have you ever applied or worked at JX Enterprises before? Yes  No
If so, when?

*Type of employment applying for:


Education
School Name Course of Study (Major) GPA Number of Years Attended Diploma/
Degree
(yes/no)
High
City: State: 		Yes  No
College
City: State: 		Yes  No
Technical
City: State: 		Yes  No
Other
City: State: 		Yes  No

Employment History
Present or Last Employer: Address:
City:
State: Zip Code:
Job Title: Phone Number:  (555-555-1234)
Dates of Employment
from: Pick a date to: Pick a date orPresent		 Reason for Leaving:
Starting Pay:  (20,000/15.50) Ending Pay:  (20,000/15.50)
Name of Manager:
If currently employed, may we contact your manager? Yes  No


Previous Employer: Address:
City:
State: Zip Code:
Job Title: Phone Number:  (555-555-1234)
Dates of Employment
from: Pick a date to:  Pick a date		 Reason for Leaving:
Starting Pay:  (20,000/15.50) Ending Pay:  (20,000/15.50)
Name of Manager:


Previous Employer: Address:
City:
State: Zip Code:
Job Title: Phone Number:  (555-555-1234)
Dates of Employment
from: Pick a date to: Pick a date		 Reason for Leaving:
Starting Pay:  (20,000/15.50) Ending Pay:  (20,000/15.50)
Name of Manager:

Personal Information
*Are you legally authorized to work in the U.S.? Yes  No
(NOTE: You will be required to furnish documents to verify your eligibility for employment in accordance with the Immigration Reform & Control Act and your employment is contingent upon furnishing such documents.)
*Are you at least 18 years of age? Yes  No
Have you ever been convicted of any misdemeanor or felony in the last 7 years? Yes  No
(A conviction does not automatically bar you from employment. It will be considered only as it may relate to the job you are seeking. You are not obligated to disclose sealed or expunged records of conviction or arrest.)
If yes, provide details.
*Are you able to work overtime if required? Yes  No
*Do you possess a valid CDL? Yes  No
If applying for a Service Technician position, do you possess your own tools? Yes  No

Special Skills
If you are an experienced operator of any office machines or equipment, please check.
Copy Machine Fax Machine Scanner    Other
Computer programs fluent in Excel Word Power Point Access    Other
Program/software knowledge, please list.
If you are an experienced operator of any manufacturing machines or equipment, please list.
Do you have any other skills you wish to mention?

Professional References
*Name: *Best time to contact:
*Relationship to applicant:
*Home Phone:  (555-555-1234) Work Phone:  (555-555-1234)
 
Name: Best time to contact:
Relationship to applicant:
Home Phone:  (555-555-1234) Work Phone:  (555-555-1234)

Please read the following statements carefully before you digitally sign your name.
Your Initials
* I certify that the information provided by me in this application is true and complete to the best of my knowledge. I understand that any false statements or omissions may result in my application being rejected or, if I am employed, may lead to my immediate dismissal. I agree that the company shall not be held liable in any respect if my application is rejected or my employment is terminated for that reason. You are hereby authorized to verify the information that I have supplied. I authorize the companies, schools, and persons named above to give any information requested regarding my education, employment and qualifications, and release and hold harmless JX Enterprises, Inc. and the companies, schools and persons from any liability. I understand and agree that, if hired, my employment is at-will and for no definite period and may be terminated at any time without prior notice and without cause, and that this application or any company policy, procedure or handbook is not and should not be considered a contract of employment. I further understand that any offer of employment may be conditioned upon the results of a physical examination and drug screen. (If this is a job requirement, you will be notified.)
 
Your Initials
* I have read and understand the preceding statements. I understand the company uses Electronic signatures and agree that when I click the Submit Application button below, I have consented to the use of the electronic signature method to sign this employment application. ( I understand I can revoke this electronic signature method at anytime by submitting the request in writing and faxing it to the HR office).

 

A Summary of Your Rights
Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every "consumer-reporting agency" (CRA). Most CRAs are credit bureaus that gather and sell information about you -- such as if you pay your bills on time or have filed bankruptcy -- to creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C. §§1681-1681u, at the FTC's web site. The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a state or local consumer protection agency or a state attorney general to learn those rights.
  • You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you—such as denying an application for credit, insurance, or employment—must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report.
  • You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently. There is no charge for the report if a person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action. You also are entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars.
  • You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRA’s—to which it has provided the data—of any error.) The CRA must give you a written report of the investigation, and a copy of your report if the investigation results in any change. If the CRA's investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.
  • Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source.
  • You can dispute inaccurate items with the source of the information. If you tell anyone—such as a creditor who reports to a CRA—that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you've notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error.
  • Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies.
  • Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA—usually to consider an application with a creditor, insurer, employer, landlord, or other business.
  • Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission.
  • You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.
Your Initials
* I acknowledge that I have read the above information.

 

JX ENTERPRISES, INC.
DISCLOSURE AND RELEASE FOR MOTOR VEHICLE RECORDS
Your Initials
* I understand and agree that in connection with my job duties at JX Enterprises, Inc. regarding the operation of company owned vehicles or eligibility to perform errands, JX Enterprises, Inc. may request information regarding my driving record from consumer reporting agencies, including, but not limited to federal, state and local agencies that maintain such records.

Your Initials
* I, the undersigned, hereby voluntarily and knowingly authorize and request any consumer reporting agency; law enforcement agency; federal, state or local agency that maintains driving records; or other persons or organizations having knowledge or information about my driving record to furnish JX Enterprises, Inc., and/or its employees, agents, or representatives, with any and all information in their possession regarding my driving record in connection with an application for or retention of employment, or eligibility to operate company vehicles or perform company errands. Further, I hereby release from liability and hold harmless all persons, corporations, and other organizations supplying this information, and JX Enterprises, Inc., its employees, agents or representatives from any claim or damage, which may result.
 
Upon emplyment, JX Enterprises, Inc. will require an official signature below.

Applicant's Signature: _________________________________________ Date: ____________
 
 
 

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