Robert V. Jensen, Inc.
Employment Application (Please Print)
Address:
Personal Information
Position applying for:
Days and hours you are available for work:
Days and hours you are available for work:
How did you hear about Robert V. Jensen, Inc. and this job opening:
If yes, state dates and position:
Are you able to perform the essential functions of the job for which you are applying,
(Note: Robert V. Jensen, Inc. complies with the ADA and considers reasonable accommodation(s) that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)
Robert V. Jensen, Inc. may refuse to hire relatives of present employees if doing so could result in actual or potential problems in supervision, security, safety, or morale, or if doing so could create conflicts of interest.
Education, Training and Experien
Employment History
List below all present and past employment starting with your most recent employer (last 5 years is sufficient).
You must complete this section even if attaching a resume.
References
List below three persons not related to you who have knowledge of your work performance within the last 3 years.
Applicant Statement
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for
employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I,
the undersigned applicant, have personally completed this application. I understand that any omission or misstatement
of material fact on this application or on any document used to secure employment shall be grounds for rejection of this
application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize Robert V. Jensen, Inc. to thoroughly investigate my references, employment history, education and
other matters related to my suitability for employment (excluding criminal background information) unless otherwise
specified above. I further, authorize the references I have listed to disclose to the Company any and all letters, reports
and other information related to my work records, except for salary history, without giving me prior notice of such
disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations,
partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such
investigation or disclosure
I understand that in compliance with federal law, all persons hired will be required to verify identity and eligibility to
work in the United States and to complete the required employment eligibility verification document form upon hire.
I understand that Robert V. Jensen, Inc. does not unlawfully discriminate in employment and no questions on this
application are used for the purpose of limiting or excusing any applicant from consideration for employment on a basis
prohibited by applicable local, state or federal law.
I understand that nothing contained in the application, or conveyed during any interview which may be granted or
during my employment, if hired, is intended to create an employment contract between me and the Company. In
addition, I understand and agree that if I am employed, my employment is at-will, meaning it is for no definite or
determinable period and may be terminated at any time, with or without notice, at the option of either myself or the
Company, and that no promises or representations contrary to the foregoing are binding on the Company unless made
in writing and signed by me and the Company’s President.
DO NOT SIGN UNLESS YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
Please be advised that Robert V. Jensen, Inc. will consider qualified applicants, including those with criminal histories,
in a manner consistent with state and local “Fair Chance” laws.
I have read, fully understand and accept all terms of the above Applicant Statement.
Robert V. Jensen, Inc. is an Equal Opportunity Employer and a Drug-Free Workplace.
