Updated 2/14

JAMBA JUICE EMPLOYMENT APPLICATION Personal Information

Last Name First Name Middle Name Phone Number ( ) - Home Work

( ) - Home Work

Address

City State Zip 1. What position are you applying for?

2. Are you 16 years of age or older? 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:

Are you willing and available to work at any other Jamba Juice locations? Yes No If yes, where?

Do you have a valid drivers license? Yes No

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

Yes No

Wed Thurs Fri Sat Sun Mon Tues

From

To

Updated 2/14

E

Education

School Name of School City & State Graduated Year Degree/Major

High School Yes No College (Undergrad) Yes No Grad School Yes No Trade, Business, Correspondence School Yes No

Other training, please specify Yes No

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 Number

From Mo/Yr

To Mo/Yr

Title or position Starting Salary

Ending Salary

Reason for Leaving

Professional References (provide three)

Name Relationship Years Acquainted Phone # Email address

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.

Applicant Signature Date

RS O NA L I NFORM AT I O