Last Name* First Name* M.I.

Address*

City*State*Zip*

Email*

Phone # (including area code)*

Position you are applying for*

Type of Work*

Select One Part Time Full Time

If hired, when would you be able to start?

Tell us why you want to work at Jump Club*

Days/Hours Available

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Employment may be contingent upon applicants passing a drug screen and criminal background check.

Have you ever been convicted of a felony?*

Select One Yes No

if yes, describe the circumstances.

Employer 1

Name

Street Address

CityState Zip

Position/Duties

Supervisor

Phone

Reason for leaving

Employer 2

Name

Street Address

CityState Zip

Position/Duties

Supervisor

Phone

Reason for leaving

Employer 3

Name

Street Address

CityState Zip

Position/Duties

Supervisor

Phone

Reason for leaving

NamePhone # Years KnownOccupation

NamePhone # Years KnownOccupation

NamePhone # Years KnownOccupation

High School

Name of SchoolDid you graduate?

Select One Yes No Still Going

Extracurricular Activities

College

Name of SchoolField of StudyDegree

Select One None Still Going 2 Years 4 Years > 4 Years

Extracurricular Activities

Business/Technical/Other

Name of SchoolField of StudyDid you graduate?

Select One Yes No Still Going

If yes, describe your degree/diploma.

Number of years completed

Briefly describe any skills or experience (including customer service experience) of yours that would make you a great addition to the jump club team.*

APPLICANT STATEMENT - Please read carefully before entering your name and date below

I certify that all the information on this application is complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal. I authorize JUMP CLUB to confirm all statements contained in this application as it relates to the position I am seeking. I authorize any party contacted by JUMP CLUB to furnish the above-mentioned information. I understand JUMP CLUB hires only individuals who are legally eligible to work in the United States. I understand a background check will be completed prior to my employment.

Entering your name and date is confirmation that you understand and agree to the above statement.

Name*Date*