Employment Application

Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Enter Email Confirm Email

Main Phone*

Secondary Phone

Social Security Number*

Are you legally eligible for employment in this country?*

YES
NO

Have you ever been convicted of or pleaded no contest to a felony?*

YES
NO

Education Information

Highest leve of education completed?*

High School
Some College
Associates Degree
Bachelor's Degree
Master's Degree
Doctorate

Position and Availability

Position Applied For*

Skills*

Salary Desired*

Shift Preferred*

First Shift
Second Shift
Third Shift

Hours Available

Available From*

: Hour

Minutes

Available To*

: Hour

Minutes

If hired, on what date can you start working?*

Are you available to work overtime?*

YES
NO

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?*

YES
NO

If no, describe the functions that cannot be performed

Employment History

Last Employer*

Phone*

Address (Last Employer)*

Street Address Address Line 2 City State ZIP Code

Employed From*

Employed To*

Starting Pay*

Ending Pay*

Reason you left?*

Download Required Files

Download the below forms, fill them out completely, and sign them. Once you sign them you can scan them and attach them below or take a picture with your phone of the forms and attach them below. The best option is to scan them onto a computer because it requires less steps and the quality is better.

Download Form | Attendance And Punctuality

Download Form | Consent To Drug Test

Download Form | DHS Employment Eligibility Verification

Download Form | Equipment Distribution Log and Acknowledgement

Download Form | W-4 Employee's Withholding Allowance Certificate

Upload Filled Out & Signed Forms

Upload the files that you downloaded and filled out from the above section.

Upload File | DHS Employment Eligibility Verification Form*

Max. file size: 128 MB.

Upload File | W-4 Form*

Max. file size: 128 MB.

Upload File | Consent To Drug Test Form*

Max. file size: 256 MB.

Upload File | Attendence & Punctuality Form*

Max. file size: 128 MB.

Upload File | Equipment Distribution Log & Acknowledgement Form*

Max. file size: 128 MB.

Electronic Consent Signature

Certification of Application:

I certify that all of the information provided and any attachments are true and complete and to the best of my knowledge. I understand that any willful misrepresentation, false statement, or omission by me on this application will be cause for rejection of my application or termination of my employment. I authorize investigation of all statements made on this application and any attachments and I release all persons, companies, and organizations from liability for providing or receiving such information. I further understand that this employment application and other employment related documents are not contracts of employment and that any oral or written statements to the contrary are hereby expressly disavowed.

Electronic Signature*

Date*

Consent*

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

The JIREH Group

Call Us Anytime

Email Us

Personal Information

Education Information

Position and Availability

Hours Available

Employment History

Download Required Files

Upload Filled Out & Signed Forms

Electronic Consent Signature