Jude's Barbershop - Where Guys Get Their Haircut

First Name: Last Name: Maiden Name (if applicable): Address: City: State: Zip: Daytime Phone: Evening Phone: Are you looking for a career or a job? Are you interested in further education?

yes

no

maybe

If yes, in what areas? Position Applying For:

Stylist/Barber

Management

Educator

Are you a licensed cosmetologist or barber?

yes

no

If yes, how many years of experience have you had as a licensed cosmetologist or barber? What is your cosmetology/barber license number? If no, when do you expect to receive your cosmetology or barber license? Have you applied to our company previously?

yes

no

If yes, when? Are you at least 18 years old?

yes

no

Are you legally eligible for employment in the United States?

yes

no

Are you able to perform the essential functions of the job position with or without reasonable accommodation?

yes

no

What reasonable accommodation, if any, would you require? Describe your style: Describe your personality: Why are you interested in working for Jude's Barbershop? Why will you be an asset to Jude's Barbershop? Describe a few of your goals: Why have you not been able to achieve these goals before? What do you like about this industry? What don't you like about this industry?

(1) Employer Name: Job Duties: Reason For Leaving: Beginning Date of Employment (Month/Year): Ending Date of Employment (Month/Year): (2) Employer Name: Job Duties: Reason For Leaving: Beginning Date of Employment (Month/Year): Ending Date of Employment (Month/Year): (3) Employer Name: Job Duties: Reason For Leaving: Beginning Date of Employment (Month/Year): Ending Date of Employment (Month/Year):

High School Name: Did you receive a diploma?

yes

no

College Name: Did you receive a degree?

yes

no

If yes, what area of study is your degree in? List any other training (graduate, technical, vocational): List awards, honors, special achievements:

Name: Phone: Relationship: What would this person say about you? Name: Phone: Relationship: What would this person say about you? Which of the following led you to apply at Jude's Barbershop? (Check all that apply)

	Tv Commercial
	Receieved a Flyer/Letter/Application in the Mail
	Newspaper Classifieds Ad
	Mlive.com Employment Ad
	News Story on TV or in the paper
	From a Jude's Customer
	I am a Jude's Customer
	From a Jude's Employee
	Jude's Barbershop Website
	Drove by a Jude's Barbershop Location
	Cosmetology or Barber School - Salon Day/Career Day
	Craigslist
	Other

If you were offered employment, when would you be able to begin working? The Jude's Barbershop location where I would MOST like to work is… Downtown Grand Rapids Plainfield - Cheshire Area Jenison Standale East Grand Rapids Grandville Kentwood East Beltline West River Drive Fuller Allendale Zeeland Wyoming (Byron Center Ave.) Grand Haven Lansing Kalamazoo Cascade - Forest Hills Portage S. Washington - Downtown Lansing The second Jude's Barbershop location where I would most like to work is…. Downtown Grand Rapids Plainfield - Cheshire Area Jenison Standale East Grand Rapids Grandville Kentwood East Beltline West River Drive Fuller Zeeland Wyoming (Byron Center Ave.) Grand Haven Lansing Kalamazoo Cascade - Forest Hills Portage S. Washington - Downtown Lansing The third Jude's Barbershop location where I would most like to work is…. Downtown Grand Rapids Plainfield - Cheshire Area Jenison Standale East Grand Rapids Grandville Kentwood East Beltline West River Drive Fuller Zeeland Wyoming (Byron Center Ave.) Grand Haven Lansing Kalamazoo Cascade - Forest Hills Portage S. Washington - Downtown Lansing How many hours a week would you like to work? Please list the hours you would be able to work for each day of the week:

Mon
Tues
Wed
Thurs
Fri
Sat
Sun

Email Address:

I certify that the information provided on this Application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my Application, or if employment commences, immediate termination.

I authorize Jude's Barbershop, inc. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

yes

no

Please provide your initials as your legal signature: Today's Date: Please provide any other information you believe we should know: