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JAMBA JUICE EMPLOYMENT APPLICATION

Personal Information
Tinoco

Dominique

Last Name

Marie

First Name
Phone Number

818 Harrison Ave.


Address
Sanger
City

( 559 )
( 559 )

CA
State

1. What position are you applying for?


2. Are you 16 years of age or older?

Middle Name
900 8242
876 1636

Home
Home

Work
Work

93657
Zip

Team member
Yes

No

(For team members under the age of 18 a work permit is required)

3. Have you ever worked for Jamba Juice? If yes, please list dates and location(s).

4. Can you submit verification of your identity and eligibility to work in the U.S.?

Yes

No

5. Have you ever been convicted of a crime? (See note below)

Yes

No

(Do not respond concerning the following: arrests or detentions that did not result in conviction; convictions arising out of minor traffic violations; referrals to, and participation
in, any pretrial or post-trial diversion program; marijuana-related convictions more than two years old; convictions for which the record has been judicially ordered sealed,
expunged, or statutorily eradicated; and misdemeanor convictions for which probation has been successfully completed or otherwise discharged and the case has been judicially
dismissed.)

If yes, please list convictions that are a matter of public record except as stated above:
(A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. Factors including but not limited to age at the time of the offense, type of offense and relevance
to the job for which you are applying, seriousness and nature of the offense, and rehabilitation will be taken into account.)

Availability (stores only)


Total available work hours per week: 28
Are you willing and available to work at any other Jamba Juice locations?
If yes, where?
Do you have a valid drivers license?

Yes

Yes

No

No

Do you own or lease a vehicle that you are willing to use for business purposes (subject to the
Companys expense reimbursement policy)?
Wed
From
To

Updated 2/14

Thurs

Fri

Sat

Sun

Mon

Yes

No
Tues

5:00 p.m

5:00 p.m

5:00 p.m

1:00 p.m

1:00 p.m

5:00 p.m

5:00 p.m

9:00 p.m

9:00 p.m

9:00 p.m

5:00 p.m

5:00 p.m

9:00 p.m

9:00 p.m

E
Education
School
High School

Name of School

City & State

Graduated
Yes
No

Year

College (Undergrad)

Yes

No

Grad School

Yes

No

Trade, Business, Correspondence School

Yes

No

Other training, please specify

Yes

No

Starting
Salary

Ending
Salary

Employment Information
Starting with your most recent job, please list present and past employment.
All information is required do not write see resume in this section.
Company name, Address and Phone
From
To
Title or position
Number
Mo/Yr Mo/Yr

Professional References (provide three)


Name
Relationship

Marcos Mireles
Scott Okada

Stephen Schmidt

Years Acquainted

Phone #

Degree/Major

Reason for Leaving

Email address

Educator

1 year

(559) 696-6288

marcos_mireles@sanger.k12.ca.us

Educator

1 year

(559) 287-7662

scott_okada@sanger.k12.ca.us

Educator

1 year

stephen_schmidt@sanger.k12.ca.us

Applicant Statement
JAMBA JUICE IS AN EQUAL OPPORTUNITY EMPLOYER. PLEASE READ THE FOLLOWING STATEMENT CAREFULLY.
I declare under penalty of perjury that I personally completed this application and that, to the best of my knowledge, the information contained in this
application is true and complete. I understand that any false information or signicant omissions may disqualify me from further consideration of
employment and, in the event I become employed, may result in the termination of my employment if discovered a t a later date.
I understand and agree that nothing contained in this application is intended to create an employment contract between me and the company. I also
understand and agree that if I am hired, my employment with the company will be at will, and may be terminated by either me or the company at any time,
with or without cause or advance notice. I understand that no promises or representations to the contrary will be binding on the company unless made in
writing signed by both me and the Chief Executive Ofcer of the company.
I authorize the references listed above, as well as other individuals whom Jamba contacts, to provide Jamba with any and all information concerning my
previous employment and any other pertinent information. Further, I release all parties and persons from all liability from any damages that may result
from furnishing such information to Jamba as well as any use or disclosure of such information by Jamba or any of its agents, employees or representatives.

Dominique Tinoco

Applicant Signature

R SONAL IN FOR MATIO


Updated 2/14

March 28, 2016


Date

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