Employee creation - Jack in the Box

Are you a rehire? *

Have you ever been convicted of a felony or released from prison/jail as a result of a crime for which you were convicted (felony or misdemeanor) within the last 10 years? *

A conviction will not necessarily disqualify you from employment but it is our policy to conduct a background investigation. Please explain indicating the charge, place and action taken.

Full Legal name *

Legal First name *

Legal Last name *

Middle initial *


Date of birth *

Home restaurant *

Hire date *

Street address *

City *

State *

Zip Code *

Social Security Number *


Contact Phone number 1 *

Contact Phone number 2

Email address *

Emergency contact name *

Emergency contact number *

Full-time (20 hours or more) or Part-time (19 hours or less)? *

Position is: *

Position *

TB clearance date (if you dont have your TB clearance date, please have this available prior to meeting with your Store Manager when finalizing your new hire paperwork)

Gender *

Ethnicity *

Have you worked in Hawaii, 20 hours or more for the past 14 weeks? *

Are you able to perform all essential functions of the job with or without accommodation and have you alerted your manager or company representative of any accommodations you may require?

Please explain.