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APPLICANT NOTE: This form is intended for use in evaluating
your qualifications for employment. It is not an employment contract. Please answer
all questions completely and to the best of your ability. False or misleading statements
are grounds for refusal or termination of employment benefits. It is the policy
of this company as an Equal Opportunity Employer to ensure that there shall be no
discrimination against any employee or applicant for employment on the basis of
age, race, color, creed, marital status, religion, sex, national origin, disability
or veteran status, or any other status protected by law.
* Denotes Required Field
Are you 18 years of age or older? *
Are you a U.S. citizen or are you legally authorized to work in the U.S.? *
Are you currently subject to a covenant not to compete, non-solicitation agreement,
confidentiality agreement, or any other type of agreement with a current or former
employer that might affect your employment with JH or a JH company? *
If yes, please explain and provide a copy of the agreement. (Limit 255 characters)
If yes, please indicate the date(mm/yy) and the position applied for.
If yes, please indicate the starting and ending dates.
List any other names, AKAs or maiden names that have been used past or present or
any other names by which you received your high school diploma or other degrees.
Also provide the approximate year this alternate name was last used, if available.
Please list all other places in which you lived during the last 7 years.
A conviction or guilty plea will not necessarily bar you from employment at JH.
In California, "crime" excludes any conviction more than 2 years old for a marijuana-related
In Illinois, applicants are not required to disclose sealed or expunged records
of conviction or arrest.
Massachusetts Applicants: An applicant for employment with a sealed record on file
with the commissioner of probation may answer "No" with respect to an inquiry herein
relative to prior arrests, criminal court appearances or convictions. In addition,
any applicant for employment may answer "no record" with respect to any inquiry
relative to prior arrests, court appearances and adjudications in all cases of delinquency
or as a child in need of services which did not result in a complaint transferred
to the superior court for criminal prosecution.
If yes, please explain. (Limit 255 characters)
Please provide details of your employment history, starting with the most recent
first. You must complete at least 1 employer block on this page. Commission,
bonus, incentive and any other forms of additional compensation should be noted
in the Other Compensation/Bonus field.
Complete if you have ever served in the US Military. Do not include current
National Guard or Military reserve status.
Please provide details of your education.
In the last 60 days, were you either unemployed or worked LESS than 40 hours? *
The following information is being requested in accordance with EEOC federal regulations.
The information is voluntary and will not be used when considering you for employment
with our company.
American Indian/AlaskanAsian/Pacific IslanderBlack/African AmericanHispanic/LatinoWhite/CaucasianOther
By signing and submitting this application, I understand and agree to the following:
Neither this document nor any other company procedures and communications are intended
to be interpreted as a promise or guarantee of future or continued employment or
as stating provisions and terms of employment. JH and JH employees recognize their
mutual right to end their employment relationship at any time and acknowledge that
such a relationship is one of employment at will. Except with respect to employment
at will, JH and JH companies reserve the right to change or make exception to its
Human Resources policies, documents, procedures and benefits, including those for
retirees, at any time without notice. No representative of JH has any authority
to make an agreement to the contrary.
It is JH's policy to verify pertinent educational and employment information and,
where required, personal data contained in this application. Accordingly, I hereby
authorize JH or those acting on its behalf to investigate any or all statements
contained in this application. I certify that the above statements are true and
correct to the best of my knowledge and that any misstatement may result in termination
from JH at any time. To enable JH to fulfill its responsibilities under the Immigration
and Control Act of 1986, employment is subject to providing proof of identity and
authorization to work in the United States satisfactory to JH.
I herby certify that all the statements and answers set forth on the application,
background questionnaire, and/or my resume are true and complete to the best of
my knowledge, and I understand that if any such statements and/or answers are found
false or that information has been omitted, such false statements or omissions will
be just cause for the termination of my employment. Further, I understand that by
requesting this information, no promise of employment is being made. I am willing
that a photocopy of this authorization be accepted with the same authority as the
original; and that if employed by the above-named company (except if employed in
the state of California), this authorization will remain in effect throughout such
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