Careers With United Juice Companies of America

Date

Date Format: MM slash DD slash YYYY

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Home Phone

Cell Phone

Are you a US citizen?*

Yes
No

Are you 18 years of age or older?*

Yes
No

Have you ever been convicted of, plead guilty, had adjudication withheld, plead nolo contendere or nolle prosequi to a crime? If yes, please explain (Note: Conviction of a crime will not necessarily disqualify you for employment. Each conviction will be judged on its merit and with respect to time and job relatedness. If you have selected "Yes", then please fill out the form below)*

Yes
No

List any languages in which you are fluent:*

How many hours can you work weekly?*

Can you work nights?*

Yes
No

Employment Desired*

Full Time
Part Time
Any

Salary Desired*

Have you ever been previously employed here?*

Yes
No

If you answered "Yes" please list the dates you were employed

Are you a veteran?*

Yes
No

Education*

Type	Name and Location	Degree/Diploma

Employment Record*

Company Name	Type of Work	Dates Worked Start/End	Rate of Pay	Reason for Leaving	Phone Number	Supervisor Name	May we contact your present employer? Yes/No

Begin with your present or most recent employer and list prior employers. Use the + sign to create additional lines.

References: Professional References Only (Do not include relatives)*

Name and Address	Phone	Occupation	Years Known

How were you referred to us?*

Special Skills

List any special skills that you may have.

Job Vacancies*

File

Consent*

I agree to the privacy policy.

I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate
my employment at any time or for any reason consistent with applicable state or federal law. This “employment
at will” policy cannot be changed verbally or in writing unless the change is specifically authorized in writing by
the Chief Operating Officer of this organization. I understand that this application is not a contract of
employment. I understand that federal law prohibits the employment of unauthorized aliens: all persons hired
must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result
in denial of employment.
I understand and authorize United Juice Companies of America to thoroughly investigate my references, credit
history (if applicable to the position), employment records, conviction records and other matter related to my
suitability for employment. I authorize all individuals, schools, and firms named therein, to provide any
information requested about me, and I release them from all liability for damage in providing this information. I
understand that employment is subject to the successful passing of all background checks and screenings such as
a pre-employment drug test and physical examination if required for the position.
I certify that all the statements herein are true and understand that any falsification or willful omission shall be
sufficient cause for dismissal or refusal of employment.

*All jobs listed are in Vero Beach Florida.

Application