Employment Application

First Name

Last Name

Address

City

State

Zip Code

Emergency Contact Information

Current Electrical Licenses Held include License Number

If you are not a citizen of the United States, are you eligible to work in the U.S. and would you be able to provide the necessary documents of proof of the legal right to work upon hire?

Yes

Are you under 18? (If you are under 18 and still in high school, you may be required to provide a work permit upon hire.)

Yes

How did you hear about this career opportunity?

Craigslist.org

Other website (specify below)

Employee Referral (specify below)

Advertisement (specify publication below)

Name of Referral Source

Instructions for answering the following question regarding your criminal record history:

All applicants: Do not respond "yes" concerning the following: arrests or detentions that did not result in conviction; referrals to, and participation in, any pretrial or post-trial diversion program; marijuana-related convictions more than two years old; convictions for which the record has been judicially ordered sealed, expunged, or statutorily eradicated; convictions that occurred more than ten (10) years ago; misdemeanor convictions for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed; and first convictions for misdemeanors of drunkenness, simple assault, speeding, minor traffic violations, or disturbances of the peace or misdemeanor convictions where five (5) or more years have elapsed between the application date and the date of conviction or completion of incarceration, whichever is later.
Massachusetts applicants: An applicant for employment with a sealed record on file with the commissioner of probation may answer “no” with respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions. An applicant for employment with a sealed record on file with the commissioner of probation may answer “no” to an inquiry herein relative to prior arrests or criminal court appearances. In addition, any applicant for employment may answer “no” with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution.

Have you ever been convicted of a crime?

Yes

If YES, what was (were) the offense(s)?

Have you ever been employed by or contracted with JLC Solutions, LLC?

Full-Time

Contractor

If so when

What position did you hold?

Manager's Name

Position Desired

Salary Desired

Date Available

Have you interviewed for another position at JLC Solutions, LLC?

Yes

If so, when?

Education and Training

Indicate last level completed: (High School)

One Year

Two Years

Three Years

Four Years

Indicate last level completed: (College or University)

One Year

Two Years

Three Years

Four Years

Street Address

City

Zip Code

May we contact employer?

Yes

Starting Job Title

Final Job Title

Supervisor's Name

Phone Number

From (mo/yr)

To (mo/yr)

Starting Rate of Pay ($)

Ending Rate of Pay ($)

Business Reference Data

Reference Name

Phone

Business Relationship

Reference Name

Phone

Business Relationship

Reference Name

Phone

Business Relationship

I certify the information contained in this application is correct to the best of my knowledge, and I understand that any misstatement or omissions grounds for ending the hiring process or dismissal. I authorize verification of the information provided on this application; and authorize the references listed above to give you all pertinent information concerning my previous employment; and release all parties from all liability for any damage that may result from furnishing same to JLC Solutions, LLC. In consideration of my employment, I agree to conform to the rules and regulations of JLC Solutions, LLC. I further agree the either I or the company may terminate my employment with or without cause and with or without prior notice, at any time. Finally, I understand that no representative of the Company other than an Executive Officer has the authority to enter into any agreement for employment for any specified period or time, or to otherwise alter the forgoing.

Employment Application

Employment Application

Apply for a career with JLC Solutions.

Employment Interest

Education and Training

Employment History

Dates of Employment

Business Reference Data