JOB APPLICATION - An Equal Opportunity Employer
Please read before filling out this application

James M. Pleasants Co. does not discriminate in hiring or employment on the basis of race, color, sex, religion, genetic information, disability, national origin, citizenship, military status, or on the basis of age with respect to persons 18 years or older. No question on the application is intended to secure information to be used for such discrimination. Proof of identity and work authorization will be required upon employment in accordance with federal regulations. James M. Pleasants Co. intends to check and hold you responsible for the accuracy of the statements you make on this application. This application will receive consideration for thirty (30) days. If you have not heard from us within thirty days and wish to receive further consideration for employment, it will be necessary for you to request in writing that the company reactivate your application for another thirty days.
First Name:
Middle Name:
Last Name:
Address:
City:
State:
Zip:
Phone Number:
Are you at least 18?
Have you ever pled guilty or been convicted of a crime?
Yes     
No     
If Yes, can you explain?
High School Information
High School Name:
High School Location:
High School Grade:
College Information
College or University Name:
College Location:
Major / Course Study:
College Grade:
Graduate School Information
Graduate School Name:
Graduate School Location:
Graduate Study:
Graduate School Grade:
List of Degrees:
Employment Information
Job Applied For:
Salary Desired:
Have you ever applied here before?
Yes     
No     
When?
Have you ever worked for JMPCO before?
Yes     
No     
When?
If yes, give the name(s) if different from the one given above:
When could you report to work?:
Work History
Are you currently covered by a non-compete agreement?:
Yes     
No     
If yes, please identify the employer:
First Job
Company Name:
Start Date:
End Date:
Phone Number:
Starting Salary: /
Final Salary: /
Address:
City:
State:
Zip:
Supervisor Name:
Type of Business:
May We Contact:
Yes     
No     
Position or Title:
Responsibilities/Duties:
Reason For Leaving:
Second Job
Company Name:
Start Date:
End Date:
Phone Number:
Starting Salary: /
Final Salary: /
Address:
City:
State:
Zip:
Supervisor Name:
Type of Business:
May We Contact:
Yes     
No     
Position or Title:
Responsibilities/Duties:
Second Job Reason for Leaving:
Third Job
Company Name:
Start Date:
End Date:
Phone Number:
Starting Salary: /
Final Salary: /
Address:
City:
State:
Zip:
Supervisor Name:
Type of Business:
May We Contact:
Yes     
No     
Position or Title:
Responsibilities/Duties:
Reason for Leaving:
Relatives In Employment
First Relative Name:
First Relative Relationship:
Second Relative Name:
Second Relative Relationship:
Third Relative Name:
Third Relative Relationship:
Military Service
Branch of Service:
Service Duties:
Other Information
Special Skills:
First Reference
Name:
Occupation:
Known:
Phone:
Address:
City:
State:
Zip:
Second Reference
Name:
Occupation:
Years Known:
Phone:
Address:
City:
State:
Zip:
Third Reference
Name:
Occupation:
Years Known:
Phone:
Address:
City:
State:
Zip:
Upload Resume
Upload PDF:
Affidavit

I authorize, without liability, investigation of all statements in this application.

I authorize all schools which I attended and all previous employers to furnish to James M. Pleasants Co. my record, reason for leaving and all information they may have concerning me, and hereby release them and James M. Pleasants Co. from all liability for any damage whatsoever arising therefrom.

I authorize my neighbors, friends or others with whom I am acquainted or who are acquainted with me to furnish James M. Pleasants Co. with information used in connection with the evaluation of my qualifications as a prospective employee. I release such persons and organizations from any legal liability in making such statements.

I understand that in the event of my employment by James M. Pleasants Co. it shall be sufficient cause for dismissal if any of the information I have given in this application is false or if I have failed to give any information herein requested. I understand that proof of identity and work authorization will be required upon employment in accordance with federal regulations. In the event of my employment by James M. Pleasants Co. I agree to abide by all present and subsequently issued rules of the Company.

If hired, in consideration of my employment, I agree to comply with the policies, standards, and business ethics of James M. Pleasants Co. I understand that my employment is at will and may be terminated by me or the company at any time without additional consideration or notice. I understand that no representative of James M. Pleasants Co. (except the Chief Executive Officer) has the authority to commit to any definite term of employment or alter the at-will employment agreement, and any such agreement must be in writing.

E Signature 
Today's date will be added on submission.