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Employment Application

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Contact Information

Driving Information

The following questions are required as you will be operating Company vehicles. Your driving record will be checked for violations. Applicants must have a clean driving record in order to be considered for employment:

Employment Information

Have you ever applied for JEC Miller, Inc?

Position

Part Time
Full Time
Either

I can work the following (Check all that apply)

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Hours

Mornings
Days
Evenings
Overnights

Educational History

High School

Graduated

Technical / Trade School

Graduate

College

Graduate

Other School

Graduate

Related Skills

Do you have experience working with individuals with Developmental Disabilities?

US Military Records

Present Military Record

None
Reserve (Active)
Reserve (Inactive)

Former Employers

List your last four employers. Begin with the most current position.

May we inquire with your present employer?

May we inquire with your past employers?

Please answer the following five essay questions. Answers should be one paragraph.

Personal References

List three people - not related to you - whom you have known for a least 1 year:

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