Name: Josko Services
Price range: $$

GENERAL INFORMATION

Name *

First

Middle

Last

Application Date *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Alt. Phone/Cell

Emergency Contact Name: *

First

Last

Relationship: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

POSITION DESIRED

Position *

Full/Part Time *

Full Time
Part Time

Hours a week

Selected Value: 0

Please select hours for part time postion only.

Salary Requirement *

Start Date Available *

Are you available to work whatever schedule is necessary to help us meet our corporate objectives and obligations to our clients: *

Yes
No

If “no”, what shifts/days are you available? *

PERSONAL INFORMATION

Are you presently employed? *

Yes
No

If “yes”, may we contact your present employer? *

Yes
No

Do you have reliable transportation to get to/from work each day? *

Yes
No

To your knowledge, have you ever been employed by this Company or a subsidiary? *

Yes
No

Referral source: *

If other please describe

EDUCATION

The following information will be used only to the extent relevant to the qualifications of the position for which you are applying:

Highest grade level completed: *

Do you have a high school diploma or GED? *

Yes
No

Did you earn a college degree? *

Yes
No

Degree Earned: *

College Name: *

Year Awarded:

BACKGROUND INFORMATION

Have you ever been convicted or pled guilty or “no contest” to a misdemeanor or felony? (Do not include minor traffic infractions for which you never appeared in court, offenses which were dismissed or discharged after completion of successful probation and convictions or please which have been deemed sealed, annulled, or expunged by law.) *

Yes
No

If yes, please explain:

Have you ever been arrested or charged with any misdemeanor or felony not disclosed above for which you are out on bail or free on your own recognizance, pending disposition or trial? *

Yes
No

If yes, please explain:

Have you ever been sued in a civil action with regard to the death of, personal injury of, or intentional damage to any person or to any property? *

Yes
No

If yes, please explain:

Are you prevented from becoming lawfully employed in this country because of immigration status? *

Yes
No

Are you currently engaged in use of illegal drugs? *

Yes
No

EMPLOYMENT HISTORY

Have you ever been granted a military or government security clearance? *

Yes
No

If yes, please explain:

Do you have any special job skills or qualifications that may be relevant to the position for which you are applying? *

Yes
No

If yes, please explain:

Have you ever been dismissed from a job or asked to resign from employment? *

Yes
No

If yes, please explain:

EMPLOYMENT HISTORY LIST

Please list all previous employment for the last 10 years, including military service, beginning with your present job or last job held.

Employer:

Supervisor:

Address:

Address Line 1

City

State

Phone:

Job Title:

Reason For Leaving:

Dates of Employment:

From

Dates of Employment:

To

Employer:

Supervisor:

Address:

Address Line 1

City

State

Phone:

Job Title:

Reason For Leaving:

Dates of Employment:

From

Dates of Employment:

To

Employer:

Supervisor:

Address:

Address Line 1

City

State

Phone:

Job Title:

Reason For Leaving:

Dates of Employment:

From

Dates of Employment:

To

Employer:

Supervisor:

Address:

Address Line 1

City

State

Phone:

Job Title:

Reason For Leaving:

Dates of Employment:

From

Dates of Employment:

To

Employer:

Supervisor:

Address:

Address Line 1

City

State

Phone:

Job Title:

Reason For Leaving:

Dates of Employment:

From

Dates of Employment:

To

PERSONAL REFERENCES

Name:

First

Last

Phone:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Name:

First

Last

Phone:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Name:

First

Last

Phone:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Name:

First

Last

Phone:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Name:

First

Last

Phone:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

ACKNOWLEDGEMENT OF EMPLOYMENT TERMS

I understand that any misrepresentation, falsification or omission of this application shall be sufficient reason for refusal to hire or, if discovered after employment has begun, dismissal of my employment. I hereby authorize investigation of all matters contained in this application and agree that if the results of such an investigation are not satisfactory, any offer off employment may be withdrawn, or, if applicable, my employment may be terminated immediately. I agree to conform to and adhere to rules and regulations governing my employment. In consideration of any offer of employment, I hereby acknowledge, understand and agree that the following will constitute the terms and conditions of any such employment: Any losses or expenses incurred by my employer, its clientele, or other third parties as a result of my unauthorized actions shall be immediately reimbursed to my employer on terms that are satisfactory and acceptable to my employer. To the extent permitted by law, I agree and hereby authorize my employer to reduce my wages for any sums owed by me hereunder.

Name *

First

Last

(407) 807-0337

1727 Benbow Ct.

107 Dunbar Ave.

Monday - Friday 8:00am-6:00pm

Application

GENERAL INFORMATION

POSITION DESIRED

PERSONAL INFORMATION

EDUCATION

BACKGROUND INFORMATION

EMPLOYMENT HISTORY

EMPLOYMENT HISTORY LIST

PERSONAL REFERENCES

ACKNOWLEDGEMENT OF EMPLOYMENT TERMS

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