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Date of Application
Date Available to Start Work

Personal Information

Applicant Name
Current address
Date of birth
Gender

Emergency Contact Person

Name

Desired vacancy

Are you authorized to work in USA?
Has been convicted of any crime within the last 5 years?
Select up to five*
Weekly availability
Availability of schedule
Multiple Choice

Prior Work History

Name
Date / Time
Date of Entry
Retirement date
Retirement date

References

Name References
Address first References

Applicants Certification and Agreement

Please Read Carefully - If you answer 'No' to any of the questions below, explain in the space after the question.
I understand the employer has the right to proceed with any criminal background check.
I understand as a part of the job selection process, [ may be required to take a drug-screening test at the time of employment and if requested in accordance with the state and federal law at anytime during my employment. A test result that has been confirmed as positive will eliminate me from employment. If l refuse to sign this form and submit to drug testing, the employer will reject my application.
I understand this form is not an employment contract
I accept and confirm that all the information provided in this application is true I accept the conditions of use of the information
I understand that by signing this form that it constitutes a legal form confirming that I acknowledge and agree to the above Terms of Acceptance.
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FORM W9
Fill out the W9 form, download it and mail it to application@jaafs-ser.com to complete your application.
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