Workflow Application | Jack's Family Fund

zGrant Application - Workflow

Step 1 of 4

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Application Log #
Are you completing this application on behalf of someone else?*
- Yes
- No
Your Name*
First Last
Your Email*
Your Preferred Phone*
Preferred Phone Type*
Do you currently work for Jack's or SFM?*
- Yes
- No
What Jack's location do you work at?*
Examples: #174 - Pinson, Area 26, RSC
If not, how did you learn about the Jack's Family Fund?*
- Personal referral
- Web/Google search
- At Jack's restaurant
- Listed on another web site
Please explain in more detail how you learned about us.
If you learned about us from personal referral, who referred you? If you found us through a Google search, what were your search terms? If you learned about us while at a Jack's restaurant, was it an employee who said something or did you see signage of some kind? If you found a link to us on another web page, what web page?
What is your relationship to the applicant?*
If other, please explain.*
Section I: Applicant Information
The applicant is the individual who is experiencing the hardship/ in need of assistance.
Does the applicant currently work for Jack's or SFM?*
- Yes
- No
We are currently experiencing a lengthy delay in processing applications. Learn what other resources are available to you by visiting www.211connectsalabama.org or your local United Way.
What location?*
Examples: #174-Pinson, Area 26, RSC
Employee ID Number*
Please enter your six digit employee ID number
Please enter a number from 000000 to 999999.
How long have you been a member of the Jack's Family?*
How many months and/or years have you been employed with Jacks?
I understand that information contained within this application may be shared with my/the Applicant's supervisor, General Manager, Area Manager and/or Regional Director.*
- Yes
Applicant's Name*
First Last
Applicant's Email*
Applicant's Preferred Phone Number*
Phone Type*
Home Address*
Street Address City State Postal Code
Social Security Number Last 4 digits*
Government Issued Photo ID (File Upload)
Please upload a copy of your government issued photo ID. (E.g. driver's license, voter ID, state ID, passport)
Max. file size: 5 MB.
Employment Status*
- Full Time
- Part Time
- Unemployed
- Retired
- Disabled
- On Leave
If you are currently not working, do you receive any income or benefits?*
For example - unemployment benefits, severance pay, short-term disability, SSI/SSDI benefits, retirement income
- Yes
- No
NOW HIRING - Come join the Jack's family! We are hiring for both management and crew team positions at most restaurant locations. Learn more and apply online
Have you applied to work at Jack's?*
- Yes
- Not yet, but will
- No, not interested
Great! What location(s) are you interested in?*
May we forward your name and contact info to the Area Supervisor letting them know you are interested in working at Jack's?*
- Yes, please
- No, thank you
What type of work are you looking for?*
Please provide details of your current job search.*
You may list more than one potential employer or pending job application by clicking the "+" at the end of the row.
Potential Employer Date Applied Application Status
Employer*
You indicate your employer is Jack's. Please scroll back to the top and click "yes" under the question "Does the applicant currently work for Jack's or SFM?" and complete your employee information.
Former Employer*
Position, Pay Rate, Full or Part Time?
Reason you left position*
Date of last paycheck
Previous Job: Do you have copy of your last paystub or a notice of separation?*
- Yes
- No
Paystubs and/or notice of separation from previous employer*
Drop files here or

Max. file size: 32 MB, Max. files: 3.
Previous Employment Verification*
Without paystubs or notice of separation, how else will you verify your previous employment and pay rate?
Employer Address*
Street Address City State Postal Code
Average number of hours per week*
Salary/Hourly Wage*
How did you learn about the Jack's Family Fund?*
- Personal referral
- Web/Google search
- At Jack's restaurant
- Listed on another web site
- During the hiring/training process
Please explain in more detail how you learned about us.
If you learned about us from personal referral, who referred you? If you found us through a Google search, what were your search terms? If you learned about us while at a Jack's restaurant, was it an employee who said something or did you see signage of some kind? If you found a link to us on another web page, what web page? If you learned about during the hiring/training process, when specifically?
Are you currently enrolled as a student?*
Where are you enrolled as a student?*
How many people live in your household?*
If you live alone, please enter "1"
Please enter a number from 1 to 15.
Please list names and ages of each person in household and explain their relationship to you.*
List yourself then click the "+" at the end of the row to add a row for each person in your household.
Name Age Relationship to applicant
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Please list names and ages of each person in household and explain their relationship to you.
Example: Myself, 30; Bob, 20, my roommate; Joe, 12, my son; Chris, 8, Roommate's son
Does anyone other than yourself contribute to your household's income, and/or do you receive other sources of financial support beyond your wages?*
For example, do you receive food stamps, child support, or disability benefits? Does your spouse, roommate or child work and help pay the household bills?
- Yes
- No
If yes, please explain the source if income/support and the monthly amount.*
For example: If you receive $250/month in food stamps and your son contributes $200/month from his paycheck, write "Food Stamps=$250; Son=$200"
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Did you receive an economic stimulus payment during in spring 2020?
- Yes
- No
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Why not?
Please explain your understanding as to why you did not receive the economic stimulus payment in 2020.
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Have you received a federal stimulus check in 2021?
On Dec. 29, 2020, the IRS began issuing a second round of Economic Impact Payments as part of the Coronavirus Response and Relief Supplemental Appropriations Act of 2021. Direct deposits began on 12/29/20 and paper checks/debit were scheduled to begin distribution on 12/30/20. Have you received this most recent stimulus payment yet?
- Yes
- No
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How much was your stimulus payment and how will/did you spend it?
Please be as specific as possible. For example, "I received $1200. $400 went toward my electric bill and the remainder went toward my past-due rent."
How much was your tax refund this year and how will/did you spend it?*
If you used it to pay bills, what bills did you pay? If you did not receive a tax refund, please explain why.

Section V: Applicant Certification
(Must be Completed)
I certify that to my knowledge I am in compliance with all laws, statutes and regulations restricting U.S. persons from dealing with any individuals, entities or groups who are subject to economic sanctions imposed by the U.S., such as countries subject to embargoes or groups of individuals, such as terrorists and narcotics traffickers.

I consent to the processing of my personal data contained in this Application for verification purposes and the potential disbursement of a grant from the Jack’s Family Fund. I further consent to the transfer of the contents of this Application to the Fund located in Birmingham, Alabama, USA, the Jack’s Family Fund Administrator, the Jack’s Family Fund Board of Directors or Allocation Committee Members.
I further certify to the Fund that the information contained in this Application is true and correct.
By accepting a gift from the Fund, I agree to provide copies of the following materials if requested by the Foundation: receipts demonstrating the emergency hardship, my expenditure, and documentation illustrating my relationship to the Applicant, if I am submitting this application on behalf of someone else.
Application Completed By*
First and Last Name of person completing the application.
Signature*
Date*
Month
Day
Year
When you hit Next Step...
...your application will be submitted to us and you will be redirected to the Monthly Budget form. It will ask for your application number. That can be found on the confirmation email you should have received. (Check spam if you do not see it waiting in your Inbox.) If you don't have it, don't worry. Use the same name and email address you did on this form and we should be able to match your budget up to your application. Unless you are only requesting contribution toward a loved one's funeral, we cannot begin processing your application until the budget form is submitted.
Your application has been rejected without review.
In most cases this happens because the information on your application triggered a red flag. Red flags are based on previous interactions with the Jack's Family Fund. If you wish to appeal, please hit "save and continue later" and send that link to us through our "contact us" form.

Hotel Name	Front Desk Phone #	City	Total Nightly Rate

Jack's Family Fund

zGrant Application - Workflow

Step 1 of 4

Section I: Applicant Information

Section II: Request for Financial Assistance

Supporting Documents

Every applicant must submit:

Section III: Other Assistance

Section IV: Prior Fund Assistance

Section V: Applicant Certification

When you hit Next Step...

Your application has been rejected without review.

Potential Employer	Date Applied	Application Status

Name	Age	Relationship to applicant