Job Application - Jackson Square Laundromat, Jamaica Plain
Please complete this application accurately. In order for us to consider your application, please email your resume to info@jacksonsquarelaundromat.com.
Name *
(Last, First)
Your answer
Email Address *
Your answer
Current Address *
(street, city, state, ZIP)
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE U.S.A? *
POSITION APPLIED FOR *
IF YOUR APPLICATION IS CONSIDERED FAVORABLY, ON WHAT DATE WILL YOU BE AVAILABLE FOR WORK? *
Your answer
WOULD YOU WORK? *
Required
ARE YOU 18 YEARS OR OLDER? *
REFERRED BY *
(name or organization)
Your answer
SALARY DESIRED *
(hourly wage)
Your answer
HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE? *
EDUCATION
HIGH SCHOOL (Name & Location, # of years attended, Did you graduate?) *
If none, type "NA"
Your answer
COLLEGE (Name & Location, # of years attended, Did you graduate?) *
If none, type "NA"
Your answer
TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL (Name & Location, # of years attended, Did you graduate?) *
If none, type "NA"
Your answer
EMPLOYMENT HISTORY
Please list your 3 most recent employers, starting with the last one first
Former employer #1 *
Dates employed, Name and address of employer, Position and salary, Reason for leaving
Your answer
Former employer #2
Dates employed, Name and address of employer, Position and salary, Reason for leaving
Your answer
Former employer #3 *
Dates employed, Name and address of employer, Position and salary, Reason for leaving
Your answer
REFERENCES
Please list below 3 references
Reference #1 *
Name, Phone Number, Address, Business (if applicable)
Your answer
Reference #2 *
Name, Phone Number, Address, Business (if applicable)
Your answer
Reference #3 *
Name, Phone Number, Address, Business (if applicable)
Your answer
ELECTRONIC SIGNATURE

“I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND COMPLETE. I UNDERSTAND
THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.
I AUTHORIZE INVESTIGATION OF ALL MY STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE
TO GIVE YOU ANY AND ALL INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM
ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.
I GIVE AUTHORIZATION TO HAVE MY MOTOR VEHICLE RECORD CHECKED AND VERIFIED AND, IF HIRED, IT MAY BE
CHECKED PERIODICALLY THROUGHOUT MY EMPLOYMENT. I VERIFY THE VEHICLE INFORMATION I GAVE IS COMPLETE
AND ACCURATE. I UNDERSTAND THAT IF HIRED I MAY BE REQUIRED TO MAINTAIN VALID AUTO INSURANCE AND DRIVER’S
LICENSE AS A CONDITION OF EMPLOYMENT.
I UNDERSTAND THAT NOTHING CONTAINED IN THIS APPLICATION, OR CONVEYED DURING ANY INTERVIEW WHICH
MAY BE GRANTED, IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT.
I UNDERSTAND THAT FILLING OUT THIS FORM DOES NOT INDICATE THERE IS A POSITION OPEN AND DOES NOT
OBLIGATE YOU TO HIRE ME.
I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS AT WILL WHICH MEANS IT IS FOR NO DEFINITE
PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES OR SALARY, BE TERMINATED AT ANY TIME
WITHOUT ANY PRIOR NOTICE.
IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF
EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL
PENALTIES AND CIVIL LIABILITY.
I UNDERSTAND THAT ALL OFFERS OF EMPLOYMENT ARE CONTINGENT UPON THE PRODUCTION OF THE PROPER
DOCUMENTS FOR COMPLETION OF THE I-9 FORM.”
Signature *
Type your name in this box to indicate your electronic signature
Your answer
Date *
Your answer
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