Join Our Team

It is the policy of Kelly Jae’s Lakeside to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status

Name *

First

Last

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Number of years at this address. *

Phone

Email *

Driver's License Number *

Social Security Number will be requested upon hire.

Emergency Contact *

First

Last

Who should we contact if you are involved in an emergency?

Relationship to you. *

Emergency Contact Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Phone *

Job Position Applying For *

How many hours per week can you work? *

Desired Salary (per hour). *

Who referred you to us?

Do you have any friends or relatives who work here? If yes, list here:

Have you applied to our company previously? *

Yes
No

If yes, when?

Are you at least 18 years old? *

Yes
No

How will you get to work? *

Are you willing to work any sift, including nights and weekends? *

Yes
No

If no, please state limitations.

If applicable, are you available to work overtime? *

Yes
No

If you are offered employment, when would you be available to begin work? *

If hired, are you able to submit proof that you are legally eligible for employment in the United States *

Yes
No

Are you able to perform the essential functions for the job position you seek with or without reasonable accommodation? *

Yes
No

What reasonable accommodation, if any, would you request?

How good are your customer service (0-5)

Selected Value: 0

0- poor to 5- excellent

Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.

Name of Employer

Supervisor's Name

Address of past employer

Address Line 1

Address Line 2

City

State

Zip Code

Please list your job duties.

Dates of Employment

Reason for leaving.

Name of Employer

Supervisor's Name

Address of past employer

Address Line 1

Address Line 2

City

State

Zip Code

Please list your job duties.

Dates of Employment

Reason for leaving.

Name of Employer

Supervisor's Name

Address of past employer

Address Line 1

Address Line 2

City

State

Zip Code

Please list your job duties.

Dates of Employment

Reason for leaving.

Education and Training

List your College/University name and address

Did you receive a degree?

Yes
No

List your High School/GED name and address

Did you receive a diploma or GED?

Yes
No

Please list any other training (graduate, technical, vocational).

List any current licenses or certifications that you hold.

List any awards, honors or special acheivements.

Did you serve in the military?

Yes
No

What branch? Please list any specialized training.

References

List any two non-relatives who would be willing to provide a reference for you.

Name of Reference *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Name of Reference *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer.

Certification

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Kelly Jae’s Lakeside to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship if created, I understand that unless I am offered specific written contract of employment signed on behalf of the organization by its owner employment relationship will be “at-will”. In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, employer will the right. Moreover, no agent, representative, or employee of Kelly Jae’s Lakeside, except in a specific written contract of employment signed on behalf of the organization by its owner, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

Signature

Date / Time

Date

Time

Fill out an application

Applicant Employment History

Education and Training

References

Certification