Blended Star, LLC
a Jamba Juice Franchise
DATE OF APPLICATION
MONTH
EMPLOYMENT APPLICATION
DAY
YEAR
● It is the company's policy to provide equal opportunity in conformance with all applicable laws.
● In accordance with the immigration Reform and Control act of 1986, any offer of employment is conditioned upon satisfactory proof
of applicant's identity and legal ability to work in the United States.
● This company E-verifies employment eligibility as per Utah State Law.
PERSONAL INFORMATION
NAME: LAST
FIRST
MIDDLE
HOME PHONE
(
ADDRESS
CITY
CELL PHONE
)
STATE
(
ZIP CODE
(
IF YOU ARE UNDER 18 YEARS OF AGE AND STILL ATTENDING HIGH SCHOOL?
YES ___
)
DAYTIME/MESSAGE
)
NO ___
EMPLOYMENT DESIRED
WHAT TYPE OF WORK ARE YOU INTERESTED IN?
WAGE DESIRED?
ARE YOU CURRENTLY EMPLOYED? YES_____
_____ NO _____
IF SO MAY WE CONTACT YOUR PRESENT EMPLOYER?
YES ____ NO ____
AVAILABILITY
ARE THERE ANY HOURS, SHIFTS, OR DAYS YOU CANNOT OR WILL NOT WORK?
YES____
NO ____
WILL YOU WORK OVERTIME IF ASKED? YES ___ NO ___
IF YES, WHEN?
Please indicate the times you are available for work each day.
DAY
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
From
To
Total Hours available per week:________________
Work schedules may vary from week to week and occasionally employees are asked to stay late, leave early, or come in on scheduled day off.
GENERAL INFORMATION
HAVE YOU WORKED AT A JAMBA JUICE PREVIOUSLY?
IF YES, WHEN:
SUPERVISOR'S NAME:
YES ___ NO ___
WHERE:
REASON FOR LEAVING:
DO YOU HAVE ANY CLOSE FRIENDS OR RELATIVES CURRENTLY EMPLOYED WITH JAMBA JUICE?
IF SO, WHERE? _________________________________________________
YES____ NO ____
IF OFFERED EMPLOYMENT, CAN YOU PROVIDE PROOF OF ELIGIBILITY TO WORK IN THE UNITED STATES PRIOR TO STARTING WORK?
YES____ NO ____
ARE YOU ABLE TO PERFORM ALL THE ESSENTIAL FUNCTIONS OF THE JOB WITH OR WITHOUT REASONABLE ACCOMMODATIONS FOR WHICH YOU ARE APPLYING?
YES _____ NO _____
HAVE YOU EVER BEEN CONVICTED OF A CRIME, INCLUDING EITHER A FELONY OR A MISDEMEANOR? A "conviction" includes a plea, verdict or finding of guilt
regardless of whether sentence was imposed by the court. [You must not list (1) convictions related to marijuana more than two years ago (other than convictions of transporting
or giving away more than one ounce of marijuana), (2) convictions which have been judicially sealed, expunged or statutorily eradicated, (3) misdemeanor convictions for which
probation has been successfully completed or otherwise discharged and the case has been dismissed by the court, and (4) any information concerning a referral to, and
participation in, any pretrial or post trial diversion program. ____YES _____NO
IF YES, STATE LOCATION, DATE AND DESCRIPTION (A conviction will not necessarily disqualify you from consideration for employment)
EDUCATIONAL HISTORY
SCHOOL
NAME / CITY AND STATE
LEVEL OR YEARS COMPLETED
HIGH SCHOOL
COLLEGES / OTHER
SCHOOLS
An Equal
q
Opportunity
pp
y Employer
p y
1
2
3
4
2
2
3
4
MAJOR
TYPE OF DEGREE
OR CERTIFICATE
Rev 9/10
EMPLOYMENT HISTORY
PLEASE READ CAREFULLY: BEGIN WITH PRESENT OR MOST RECENT EMPLOYER AND LIST ALL JOBS YOU HAVE HELD FOR THE PAST TEN YEARS. INCLUDE ANY
RELEVANT VOLUNTEER WORK EXPERIENCE. ACCOUNT FOR PERIODS OF UNEMPLOYMENT IN THE SPACE PROVIDED BELOW. YOU MAY ATTACH A RESUME,
HOWEVER THE APPLICATION MUST BE COMPLETED IN FULL.
TO
FROM
EMPLOYERS NAME
MO
YR
MO
YR
COMPLETE ADDRESS (STREET NO, CITY, STATE, AND ZIP CODE)
STARTING PAY
ENDING PAY
$
$
PER
FROM
YOUR JOB TITLE
IMMEDIATE SUPERVISOR
AREA CODE AND PHONE #
(
PER
TO
)
EMPLOYERS NAME
MO
YR
MO
YR
COMPLETE ADDRESS (STREET NO, CITY, STATE, AND ZIP CODE)
STARTING PAY
ENDING PAY
$
$
PER
YOUR JOB TITLE
IMMEDIATE SUPERVISOR
AREA CODE AND PHONE #
(
PER
)
PLEASE EXPLAIN ANY PERIODS OF UNEMPLOYMENT:
FROM:
MO
TO:
YR
MO
HOW DID YOU SPEND YOUR TIME ?
YR
DRUG AND ALCOHOL POLICY
THE COMPANY HAS A VITAL INTEREST IN MAINTAINING A DRUG AND ALCOHOL FREE ENVIRONMENT FOR ITS EMPLOYEES, CUSTOMERS AND
VISITORS. THEREFORE, THE COMPANY PROHIBITS THE USE OF, POSSESSION OF, DISTRIBUTION OF, PURCHASE OR SALE OF, OFFERING TO
PURCHASE OR SELL, TRANSFER OF, TRAFFICKING IN, AND WORKING OR REPORTING FOR WORK UNDER THE INFLUENCE OF, INTOXICANTS,
DRUGS OR CONTROLLED OR ILLEGAL SUBSTANCES. APPLICANTS FOR EMPLOYMENT MAY UNDERGO A POST-OFFER, PRE-EMPLOYMENT
DRUG AND ALCOHOL SCREENING AS A CONDITION OF EMPLOYMENT. RESULTS OF SUCH TESTS WILL BE KEPT CONFIDENTIAL IN
ACCORDANCE WITH APPLICABLE LAWS.
ARBITRATION AGREEMENT
I AGREE THAT ALL CONTROVERSIES, CLAIMS OR DISPUTES BETWEEN ME AND THE COMPANY (AND/OR ANY OF ITS OWNERS, EMPLOYEES,
FRANCHISES, VOLUNTEERS OR AGENTS) RELATING TO OR ARISING OUT OF THIS APPLICATION, MY EMPLOYMENT (IF HIRED) OR ANY
EMPLOYMENT TERMINATION WILL BE SUBMITTED TO FINAL AND BINDING ARBITRATION IN THE COUNTY IN WHICH I AM EMPLOYED (OR SOUGHT
EMPLOYMENT WITH THE COMPANY), FOR DETERMINATION IN ACCORDANCE WITH THE AMERICAN ARBITRATION ASSOCIATION'S ("AAA")
EMPLOYMENT ARBITRATION RULES AS THE EXCLUSIVE REMEDY FOR SUCH CONTROVERSIES, CLAIMS OR DISPUTES. DISCOVERY MAY BE
CONDUCTED TO THE SAME EXTENT AS IN A COURT OF LAW.
THE COMPANY SHALL PAY THE ARBITRATOR'S FEES AND ANY AAA ADMINISTRATIVE EXPENSES. THE ARBITRATOR MAY AWARD ALL REMEDIES
WHICH WOULD BE AVAILABLE IN COURT. POSSIBLE DISPUTES COVERED BY THIS AGREEMENT INCLUDE, BUT ARE NOT LIMITED TO, UNPAID
WAGES, CONTRACT CLAIMS, DISCRIMINATION, HARASSMENT AND RETALIATION. THIS MUTUAL ARBITRATION AGREEMENT ALSO APPLIES TO
ALL CLAIMS THAT THE COMPANY MAY HAVE AGAINST EMPLOYEE. ANY CLAIMS WHERE MANDATORY ARBITRATION IS PROHIBITED BY LAW ARE
NOT COVERED BY THIS AGREEMENT. BOTH THE COMPANY AND I ARE GIVING UP ALL RIGHTS TO A TRIAL BY JURY.
PLEASE READ AND SIGN BELOW
I CERTIFY, UNDER PENALTY OF PERJURY, THAT ALL OF THE ABOVE INFORMATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT ANY
MISREPRESENTATION, FALSIFICATION OR OMISSION OF INFORMATION MAY RESULT IN DENIAL OF EMPLOYMENT OR, IF HIRED, MAY RESULT IN
TERMINATION.. I AUTHORIZE THE REFERENCES LISTED ABOVE TO PROVIDE THE COMPANY WITH ANY AND ALL INFORMATION CONCERNING
MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THAT THEY MAY HAVE. FURTHER, I RELEASE ALL PARTIES AND PERSONS
FROM ANY AND ALL LIABILITY FOR ANY DAMAGES THAT MAY RESULT FROM FURNISHING SUCH INFORMATION TO THE COMPANY AS WELL AS
FROM THE USE OR DISCLOSURE OF SUCH INFORMATION BY THE COMPANY OR ANY OF IT'S AGENTS, EMPLOYEES, OR REPRESENTATIVES. I
UNDERSTAND THAT ANY MISREPRESENTATION, FALSIFICATION, OR MATERIAL OMISSION OF INFORMATION ON THIS APPLICATION MAY
RESULT IN MY FAILURE TO RECEIVE AN OFFER OR, IF I AM HIRED, IN MY DISMISSAL FROM EMPLOYMENT.
I UNDERSTAND THAT ACCEPTANCE OF AN OFFER OF EMPLOYMENT DOES NOT CREATE A CONTRACTUAL OBLIGATION UPON THE EMPLOYER
TO CONTINUE TO EMPLOY ME IN THE FUTURE. I AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT, HAVING NO SPECIFIED
TERM, IS BASED UPON MUTUAL CONSENT AND MAY BE TERMINATED AT WILL, WITH OR WITHOUT CAUSE, BY EITHER ME OR THE COMPANY. I
ALSO UNDERSTAND THAT THIS AT-WILL ASPECT OF MY EMPLOYMENT MAY NOT BE CHANGED OR RESCINDED EXCEPT BY AN INDIVIDUALIZED
WRITTEN EMPLOYMENT AGREEMENT SIGNED BY BOTH ME AND THE PRESIDENT OF THE COMPANY.
EMPLOYEE SIGNATURE____________________________________________ DATE_____________________