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Summary
Title:	Maintenance Electrician II/ CNC Technician
ID:	2019102704
Department:	Maintenance
Division:	Jayco
Location:	Middlebury, IN

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General Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
* Are you available to work?:	Hold Ctrl/Cmd to select multiple items
Opt-In Confirmation
	I authorize recruiters from Jayco to send text messages from 8669523320 with requests for additional information in relation to this job application only. Message/data rates apply. Message frequency varies.
Attachments
Cover Letter:	You can type in a Cover Letter or Copy/Paste from an existing document.

Office Employment Application

Jayco, Inc. is an equal opportunity employer. Applicants are considered for employment without regard to race, color, national origin, religion, sex, age, disability (unless the disability makes one unable to perform the essential functions of the position for which he or she is applying with or without a reasonable accommodation) or any other basis prohibited by law. If you are offered employment with Jayco, Inc., you will be required by federal law to furnish documents verifying your identity and showing that you are currently authorized to work in the United States.

Part I: General Information

* Expected Compensation

* Will you work over time if requested?

Yes No

* On what date would you be available for work?

* Are you on lay-off and subject to recall?

Yes No

* Have you filed an application at Jayco before?

Yes No

If "Yes," give date

* Have you been employed at Jayco before?

Yes No

If "Yes," please give reason for leaving

* Are you currently authorized to be employed in the United States?

Yes No

* Would you, now or at any time in the future, need our sponsorship in qualifying for and maintaining employment authorization?

Yes No

* Are you 18 years of age or older?

Yes No

If "No," what is your age?

Have you been convicted of a felony or misdemeanor other than minor traffic violations? (Conviction will not automatically disqualify applicant from employment. You do not have to reveal convictions that have been erased or sealed.)

Yes No

If "Yes," please explain

Can you understand written and spoken English well enough to receive and follow directions? (Answering "œNo" will not automatically disqualify applicant for employment.)

Yes No

Part II: Specific Skills and Experience

Please check all that apply in the checklist below.

OPERATING SYSTEMS

	Macintosh
	Windows
	Other (Please specify)

SOFTWARE APPLICATIONS

	Microsoft Outlook
	Microsoft Word
	Microsoft Excel
	Microsoft PowerPoint
	Microsoft Access
	Other (Please specify)

Other

Part III: Employment Record

Please list all of your employment for the last 5 years, starting with your most recent employer. If there are lapses between employment dates, please explain.

Most Recent Employer

Name

From

Address

City

State

Zip

Phone

Job Title

Immediate Supervisor

Salary/Hourly Rate

Job Duties

Reason for Leaving

Previous Employer

Name

From

Address

City

State

Zip

Phone

Job Title

Immediate Supervisor

Salary/Hourly Rate

Job Duties

Reason for Leaving

Next Previous Employer

Name

From

Address

City

State

Zip

Phone

Job Title

Immediate Supervisor

Salary/Hourly Rate

Job Duties

Reason for Leaving

May we contact the employers listed above?

Yes No

If "No," please list those you do NOT wish us to contact and reason why.

Please state any additional information you feel would be helpful in considering your application.

Part IV: Referral

If you are being referred by a current employee, please list their name.

Referred By

Part V: Personal References - OFFICE APPLICANTS ONLY

Please list the name, address and telephone number of three references who are not related to you and are not previous employers.

Reference 1

Name

Address

City

State

Zip

Phone

Reference 2

Name

Address

City

State

Zip

Phone

Reference 3

Name

Address

City

State

Zip

Phone

Part VI: Education

Elementary School

Name

City/State

Middle School

Name

City/State

Years Completed

Graduate?

Yes No

High School

Name

City/State

Years Completed

Graduate?

Yes No

Course Pursued/Degrees Granted

College or University

Name

City/State

Years Completed

Graduate?

Yes No

Course Pursued/Degrees Granted

Business or Technical School

Name

City/State

Years Completed

Graduate?

Yes No

Course Pursued/Degrees Granted

Correspondence or Other School

Name

City/State

Years Completed

Graduate?

Yes No

Course Pursued/Degrees Granted

Do you possess any professional licenses or certificates?

Yes No

Please list job-related professional, trade, business, civic or volunteer activities and offices held. You may exclude those that indicate race, color, national origin, religion, sex, age or disability.)

Please summarize any special job-related skills and qualifications acquired from employment or other experience.

Part VII: Applicant's Statement

I certify that answers given in this application are TRUE and COMPLETE. I understand that false, misleading or omitted information in my application may result in rejection of my application, or, in the event of employment, in discharge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, and I agree to submit to medical examinations, including drug and alcohol testing, as permitted by law.
I understand that I must be able with or without reasonable accommodation to perform all of the essential functions of any job or position to which I may be assigned by the Company and that my placement upon a particular job assignment may be conditioned upon an examination or test related to my performance of the essential functions of that job.
In making this application for employment, I understand that an investigation may be made and information may be obtained through interviews with the personal references and past employers authorized. This inquiry may include information as to my character, general reputation and personal characteristics, and I consent to the conduct of this inquiry and the consideration of any statements of references or former employers that are given in response to the inquiry.
I understand that Jayco, Inc., in it's sole discretion, may seek to secure limited criminal history information on job applicants pursuant to applicable law.
I hereby release all parties, including but not limited to Jayco, Inc., personal references and previous employers, from any and all liability for any injury or damage that may result from their furnishing information to Jayco, Inc. concerning me or any action Jayco, Inc. takes on the basis of such information.
I understand that, according to federal law, all individuals who are hired must, as a condition of employment, produce certain documentation to verify their identity and whether they are currently authorized to be employed in the United States.
I understand that this application is not, and is not intended to be, a contract of employment and that any resulting employment relationship is for no fixed period of time and is terminable at any time and for any reason by me or by Jayco, Inc. My employment at Jayco, Inc. is "œat will." I further understand that statements which may be contained in policies, practices, handbooks or other Jayco, Inc. material do not create any guarantee of employment and that Jayco, Inc. has the right to modify, amend, or terminate policies, practices, benefit plans, or other Jayco, Inc. programs within the limits prescribed by law.
I understand that Jayco, Inc. employees are paid by direct deposit and agree that if I am hired I will designate and maintain an account for the direct deposit of my payroll check.

I have read, understand and agree to statements 1-9 above.

* Signature of Applicant

* Date

Equal Opportunity Employment

We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.

Gender:

Female
Male
I Choose Not to Respond

Race/Ethnicity:

	American Indian or Alaska Native (Not Hispanic or Latino) A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
	Black or African American (Not Hispanic or Latino) A person having origins in any of the Black racial groups of Africa
	Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
	Asian (Not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
	White (Not Hispanic or Latino) A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
	Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
	Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above races
	I Choose Not to Respond

Veteran Status: (Please check all that apply)

	Individual with a Disability An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
	Vietnam Era Veteran A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
	Disabled Veteran 1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
	War/Campaign/Expedition Veteran A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
	Armed Forces Service Medal Veteran A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
	Recently Separated Veteran Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
	I Choose Not to Respond

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