Employment Jones Paint and Glass Employment Application Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Jones Paint & Glass. These files are available at: transparency-in-coverage.uhc.com Step 1 of 7 14% Date* MM slash DD slash YYYY Legal Name (First, Middle, Last)* Maiden Name (if applicable) Other Name(s) Used Phone*Secondary PhoneEmail* Present Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Former Address if less than 5 years at present address or if you lived in another state. Attach sheet if more space is needed. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Who were you referred by? Are you 18 years of age or older?* Yes No If no, what is your age? List friends or relatives working for Jones Paint & Glass:Are you legally authorized to work in the U.S.?* Yes No Have you been convicted of a felony or a crime punishable by imprisonment?* Yes No Conviction will not necessarily disqualify you for the position for which you are applying.If yes, please explain: Employment DesiredWhich position(s) are you applying for?* Residential Window Installation Commercial Window Installation Retail Paint Sales Window Fabrication Automotive Glass Installation/Repair Commercial Project Manager Estimator Outside Sales Paint Outside Sales Glass/Window/Shower Doors Shipping/Receiving Customer Service Warehouse Other (explain below) Which location are you applying to?*Provo GlassProvo PaintAmerican ForkRooseveltCedar CitySt. GeorgeVernalSalary Desired* Are you available to work:* Full-Time Part-Time Shift Work Temporary Only Summer Only Other If other, please explain: Have you ever been employed by Jones Paint & Glass?* Yes No If yes, please list location and position: Have you ever applied to Jones Paint & Glass before?* Yes No If yes, please list the location you applied to: If yes, please state when you previously applied: MM slash DD slash YYYY Are you currently employed?* Yes No Can you work all production shifts if the job requires it?* Yes No If no, please explain: May we contact your current employer? Yes No Can you work all days of the week if the job requires it?* Yes No If no, what days are you available to work? Are you currently on layoff status and subject to recall?* Yes No Do you have a reliable means of transportation to get to work?* Yes No Would you be available for occasional travel?* Yes No Do you have a valid driver's license?* Yes No Military InformationLeave blank if not applicableBranch Dates of duty: Rank at discharge: What were your duties? (Include special training and duty station) EducationName of High School:* How many years attended?* Graduated?* Yes No Name of College/University If more than one, please attach additional information at end of application (included in resume is fine).Address of College/University Street Address City State / Province / Region ZIP / Postal Code How many years attended? Course or major: Graduated? Yes No Name of Business/Trade School Address of Business/Trade School Street Address City State / Province / Region ZIP / Postal Code How many years attended? Course or major: Graduated? Yes No Other? Please describe below:Describe any apprenticeship training or specialized skills you may have:List professional, trade, business or civic organizations you are affiliated with:List hobbies, sports, and extracurricular activities you are or have been involved with: Employment HistoryList in order of most current or present employer first. Please list employers for at least the last 3 years. If you need more space, please upload in a document at end of application.Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Employer Name, Address, and Telephone Number:Last position held: Start rate of pay: Finish rate of pay: Supervisor's name & title: Reason for leaving: Briefly describe your role:Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Employer Name, Address, and Telephone Number:Last position held: Start rate of pay: Finish rate of pay: Supervisor's name & title: Reason for leaving: Briefly describe your role:Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Employer Name, Address, and Telephone Number:Last position held: Start rate of pay: Finish rate of pay: Supervisor's name & title: Reason for leaving: Briefly describe your role:Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Employer Name, Address, and Telephone Number:Last position held: Start rate of pay: Finish rate of pay: Supervisor's name & title: Reason for leaving: Briefly describe your role:Additional InformationDescribe any experience, skills, and qualifications that qualify you for a position at Jones Paint and Glass:Describe the nature of special accommodations you require, if any, in order to perform the essential function of the position for which you are applying. Experience & Qualifications for DriversAll applicants for any type of driving position must provide their Motor Vehicle Report for the previous 3 years with their application.Type of Equipment (CMV, tractor/trailer, van, tank, flat, etc.) From: MM slash DD slash YYYY To: MM slash DD slash YYYY Approximate number of miles (total): Type of Equipment (CMV, tractor/trailer, van, tank, flat, etc.) From: MM slash DD slash YYYY To: MM slash DD slash YYYY Approximate number of miles (total): Type of Equipment (CMV, tractor/trailer, van, tank, flat, etc.) From: MM slash DD slash YYYY To: MM slash DD slash YYYY Approximate number of miles (total): ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED)Date MM slash DD slash YYYY Nature of accident (head-on, rear-end, upset, etc.) Date MM slash DD slash YYYY Nature of accident (head-on, rear-end, upset, etc.) Describe fatalities or injuries: Describe fatalities or injuries: Describe fatalities or injuries: Date MM slash DD slash YYYY TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS – NO PARKING VIOLATIONSLocation Date MM slash DD slash YYYY Charge Penalty Location Date MM slash DD slash YYYY Charge Penalty Location Date MM slash DD slash YYYY Charge Penalty Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No Has any license, permit, or privilege ever been suspended or revoked? Yes No Resume & AuthorizationUpload Resume or CVMax. file size: 512 MB.Upload Cover Letter if DesiredMax. file size: 512 MB.Additional FilesMax. file size: 512 MB.Consent I agree that the information provided in the application is accurate and truthful to the best of my knowledge.CAPTCHA
