Employment Application

EMPLOYMENT APPLICATION

Step 1 of 4

APEX JUMPS – 5625 SHIER RINGS ROAD DUBLIN OH 43016

APEX JUMPS is an Equal Opportunity Employer and does not discriminate on the basis of race, color, creed, national origin, ancestry, religion, age, citizenship, sex, marital or veteran status, disability or handicap, sexual orientation or any other basis prohibited by applicable law.

APEX JUMPS also takes affirmative action to employ, and advance employment of qualified women, minorities and covered veterans.

APEX JUMPS also makes reasonable accommodations for qualified individuals with disabilities, in accordance with the American with Disabilities Act (ADA) and applicable state laws.

Heading Style

Your Information

Name(Required)

First Middle Last

CELL PHONE NUMBER W/AREA CODE:

HOME PHONE NUMBER W/AREA CODE:

PRESENT ADDRESS:

Street Address City State / Province / Region ZIP / Postal Code

MAILING ADDRESS: (IF DIFFERENT)

Street Address City State / Province / Region ZIP / Postal Code

ARE YOU AT LEAST 16 YEARS OLD AND ABLE TO OBTAIN A VALID WORK PERMIT?

Yes

CAN YOU, UPON EMPLOYMENT, SUBMIT VERIFICATION OF YOUR LEGAL RIGHT TO WORK IN THE UNITED STATES?

Yes

HAVE YOU EVER PLEADED GUILTY TO AND/OR BEEN CONVICTED OF A FELONY OR MISDEMEANOR OR ANY OTHER OFFENSE, INFRACTION OR VIOLATION (INCLUDING DUI, TRAFFIC VIOLATIONS OR SIMILAR OFFENSE) WHERE YOU WERE SENTANCED TO JAIL TIME, PUBLIC OR COMMUNITY SERIVCE, PLACED ON PROBATION OR EXPERIENCED ANY OTHER CONSEQUENCES OTHER THAN THE PAYMENT OF A FINE?

Yes

IF "YES", SET FORTH THE NATURE AND DATES OF ANY CONVICTION, AND DATES OF RELEASE:

POSITION APPLYING FOR:(Required)

SALARY/HOURLY RATE DESIRED:

DATE AVAILABLE TO REPORT TO WORK:

ARE YOU APPLYING FOR:

PART-TIME EMPLOYMENT

FULL-TIME EMPLOYMENT

PLEASE INDICATE WHETHER YOU ARE ABLE TO PERFORM:

Yes

OVERTIME:

Yes

IF HIRED WOULD YOU HAVE A RELIABLE MEANS OF TRANSPORTATION TO AND FROM WORK?

Yes

ARE YOU ABLE TO PERFORM ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING, EITHER WITH OR WITHOUT REASONABLE ACCOMODATION?

Yes

Availability Table

Indicate Your Availability:

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
AM
PM

Heading Style

ABOUT YOU

HAVE YOU EVER PREVIOUSLY APPLIED FOR EMPLOYMENT HOW WERE YOU REFERRED TO ROCKIN' JUMP? OR BEEN EMPLOYED BY ROCKIN' JUMP?

Yes

ARE YOU ACQUAINTED WITH OR RELATED TO ANY ROCKIN' JUMP EMPLOYEE?

Yes

IF "YES", PROVIDE DATES AND LOCATION:

IF "YES", THE NAME(S) OF STAFF MEMBER(S):

Employment History

EMPLOYMENT HISTORY

FILL IN THE INFORMATION BELOW FOR THE MOST RECENT THREE JOBS THAT YOU HAVE HELD: (IF APPLICABLE)

Employer 1:

NAME OF EMPLOYER:

ADDRESS: (STREET/NUMBER)

CITY:

STATE AND ZIP CODE:

PHONE NUMBER:

REASON FOR LEAVING:

DATES EMPLOYED:

POSITION/JOB TITLE HELD:

ANNUAL SALARY/HOURLY WAGE:

MAY WE CONTACT THEM?

Yes

RESPONSIBILITIES:

Employer 2:

NAME OF EMPLOYER:

ADDRESS: (STREET/NUMBER)

CITY:

STATE AND ZIP CODE:

PHONE NUMBER:

REASON FOR LEAVING:

DATES EMPLOYED:

POSITION/JOB TITLE HELD:

ANNUAL SALARY/HOURLY WAGE:

MAY WE CONTACT THEM?

Yes

RESPONSIBILITIES:

Employer 3:

NAME OF EMPLOYER:

ADDRESS: (STREET/NUMBER)

CITY:

STATE AND ZIP CODE:

PHONE NUMBER:

REASON FOR LEAVING:

DATES EMPLOYED:

POSITION/JOB TITLE HELD:

ANNUAL SALARY/HOURLY WAGE:

MAY WE CONTACT THEM?

Yes

RESPONSIBILITIES:

HAVE YOU EVER BEEN TERMINATED OR SUSPENDED FROM ANY PREVIOUS EMPLOYMENT?

Yes

IF "YES", DESCRIBE THE CIRCUMSTANCES:

CONDITIONS OF EMPLOYMENT

Conditions of Employment

Please read the following statements carefully as they constitute conditions of employment with APEX JUMPS.

1. The information that I have provided on this application is accurate and true to the best of my knowledge.

2. I understand that any misrepresentation or omission of a fact on my application or during the interview process may result in the refusal of employment, or if employed, immediate termination from APEX JUMPS employment.

3. I understand that if I am 18 years or older that a successful background check will be a condition of my employment. It represents no reflection on any individual applicant. I understand that an investigative consumer report may be requested that will include information as to my character, work habits, performance and experience, along with reasons for termination of past employment from previous employers. Further, I understand that you may be requesting information concerning my motor vehicle operation history and criminal history from Federal, various states, private and insurance sources along with other public records available.

4. The persons, schools, credit companies, current or prior employers (if approved by me in the Employment History section), and other organizations or employers named in this application or designated on behalf of APEX JUMPS are authorized by me to verify the information I have provided and to provide APEX JUMPS with the information that may be requested by APEX JUMPS to arrive at an employment decision. I agree that a photocopy of this authorization be accepted with the same authority as the original. I hereby waive and release all persons, schools, credit companies, current and prior employers and other organizations from any liability arising from reliance on the disclosure of any of the above information whether in writing or orally, and further waive and release APEX JUMPS from any liability arising from reliance on the aforementioned information or the use, publication, or retention of such information within the context of its applicant review procedures.

5. I agree to protect APEX JUMPS confidential information, trade secrets, and names and addresses of clients, and I will not disclose to APEX JUMPS any confidential information of others.

6. Although APEX JUMPS makes an effort to accommodate individual preferences, business needs may make the following conditions mandatory: Overtime, shift work, a rotating work schedule, or a work schedule that includes Saturday and/or Sunday, I understand and accept these and conditions of my employment.

7. In the event that I am employed, I agree to conform to APEX JUMPS policy. I understand that my employment is at will, that the terms and conditions of my employment can be changed at APEX JUMPS option, and that my employment may be terminated with or without cause, at any time, for any reason, at the option of APEX JUMPS and myself.

8. I understand that APEX JUMPS will not employ persons who use illegal drugs and/or abuse alcohol or legal drugs, and that the company retains the right to screen from employment such individuals.

9. I will be able, if hired, to certify that I am authorized to work in the United States of America, and understand that in accordance with the Immigration Reform and Control Act I will be required to provide timely documentation of identity and employment eligibility.

I hereby certify that the information I have provided is true and correct to the best of my knowledge. I have read and agree to the Conditions of Employment, Terms of Use and Privacy Policy.(Required)

I Accept

Signature Pad

Date

Time

School name:	City and state:	Major or course of study (if applicable):	Degree achieved?	Graduation achieved?	Grade point average:
High school:
College:
Business, technical or trade school:

	Beginner	Intermediate	Advanced
Keyboarding Skills
Word
Excel
Internet