Employee creation survey - Jamba Juice

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 *


Home restaurant *

Hire date *

Date of birth *

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.