home menu about locations / contact us employment application Employment Application Pre-Employment Questionnaire, Equal Opportunity Employer Full Name: Social Security No.: Present Address: City: State: Zip Code: Permanent Address: City: State: Zip Code: Phone No.: Secondary Phone No.: Referred By Employment Desired Position: Date You Can Start: Salary Desired: Are You Employed Now?: If So, May We Inquire Your Present Employer?: Ever Applied To This Company Before?: Where: When: Education History High School Name & Location of School: Years Attended: Did You Graduate: Subjects Studied: College Name & Location of School: Years Attended: Did You Graduate: Subjects Studied: Trade, Business, Or Correspondence School Name & Location of School: Years Attended: Did You Graduate: Subjects Studied: General Information Subject of Special Study / Research Work Special Training: Special Skills: U.S. Military Or Naval Service And Rank: Former Employer Please list four (4) former employers, starting with your last one first. Starting Date Employed/Ending Date: Name & Address of Employer: Salary: Position: Reason For Leaving: Starting Date Employed/Ending Date: Name & Address of Employer: Salary: Position: Reason For Leaving: Starting Date Employed/Ending Date: Name & Address of Employer: Salary: Position: Reason For Leaving: Starting Date Employed/Ending Date: Name & Address of Employer: Salary: Position: Reason For Leaving: References List the names of three persons not related to you, whom you have known at least one year. Name: Address: Business: Years Known: Name: Address: Business: Years Known: Name: Address: Business: Years Known: Additional Application Questionnaire 1. Have you ever been convicted of a felony? YesNo If Yes, please describe: 2. Have you been convicted of a misdemeanor withing the last 5 years? YesNo If Yes, please describe: 3. Do you understand you will be requred to take a pre-employment drug test? YesNo 4. Do you agree to pay $40 for the pre-employment drug test? YesNo 5. Do you understand a background check will be conducted by our office? YesNo 6. Is Jubilee Donuts allowed to contact previous employers? YesNo 7. Are you able to lift 50lbs? YesNo 8. Are you at least 18 years of age? YesNo 9. Are you able to work weekends? YesNo 10. Are you able to work extra days? YesNo 11. Are you able to work holidays? YesNo 12. Are you able to work multiple locations? YesNo 13. Are you able to work different shifts? YesNo 14. Are there any medical reasons that will affect your job? YesNo 15. Have you smoked or used any form of tobacco in the last 90 days? YesNo 16. Will you refrain from all use of drugs and tobacco during your employment? YesNo 17. Do you agree to cover or remove all visible tattoos or piercings while on duty? YesNo 18. Any special shift restrictions? YesNo If Yes, please explain: 19. Shift Availability : Check all shifts you are interested in. AM Shift (start time 4:15am-6:00am)PM Shift (start time 11:45am-1:45pm)Production Shift (start time 8pm)Driver Shift (start time 2am) 20. Day Availability. Check all days you are able to work below. SundayMondayTuesdayWednesdayThursdayFridaySaturday 21. Check which you are interested in. (Check both if both apply.) Part TimeFull Time 22. Location availability (check all that apply) Cuyahoga FallsTallmadgeAkron Authorization "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of diability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, i understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.* In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. By clicking the "Send" button below I understand the terms written above. © 2021 Jubilee Donuts. Design by WHITTAKER MEDIA.