APPLICATION FOR EMPLOYMENT
Last Name First M.I. Date
Street Address Apartment/Unit #
City State ZIP
Home
Phone
Cell phone
!mail Address "d#s""d#s"s#"s#
Position
Applied For
Desired Ho$rly %ate & /hr Desired Salary & /yr
Date A'aila(le Ho) did yo$ learn a(o$t this openin#*
I" employed+ ,an yo$ s$(mit
'eri"i,ation o" yo$r le#al ri#ht to )or-
in the U.S.*
.S N/
Ha'e yo$ e'er )or-ed here
(e"ore*
I" so+ )hen*
.S N/
Are yo$ a'aila(le "or 0
1Che,- all that apply2
F$ll 3ime
Part time
/'ertime 3emporary
Any limitations on the ho$rs+ days or
time yo$ are a'aila(le to )or-*
.S N/ I" yes+ e4plain
Ha'e yo$ e'er had a ,riminal
,on'i,tion 1in,l$din# DUI2 or (een
s$(5e,t to de"erred ad5$di,ation*
16ill not ne,essarily e4,l$de yo$
"rom employment ,onsideration2
.S N/ I" yes+ e4plain
Hi#h S,hool Address
From 3o Did yo$ #rad$ate* .S N/ De#ree
Colle#e Address
From 3o Did yo$ #rad$ate* .S N/ De#ree
/ther Address
From 3o Did yo$ #rad$ate* .S N/ De#ree
/ther trainin# or ed$,ation related to the 5o( yo$ are applyin# "or0
EMPLOYMENT HISTORY
List present or most recent position first. May )e ,onta,t yo$r present employer* .S N/
Company 3ype o" 7$siness Phone 1 2
Address/
Lo,ation
S$per'isor
Position/
8o( 3itle
Startin# Salary & / ndin# Salary & /
8o( D$ties/ %esponsi(ilities0
Dates
mployed0
From 3o
%eason
"or
Lea'in#
May )e ,onta,t yo$r pre'io$s s$per'isor "or a re"eren,e* .S N/
Company 3ype o" 7$siness Phone 1 2
Address/
Lo,ation
S$per'isor
Position/
8o( 3itle
Startin# Salary & / ndin# Salary & /
8o( D$ties/ %esponsi(ilities0
Dates
mployed0
From 3o
%eason
"or
Lea'in#
May )e ,onta,t yo$r pre'io$s s$per'isor "or a re"eren,e* .S N/
Company 3ype o" 7$siness Phone 1 2
Address/
Lo,ation
S$per'isor
Position/
8o( 3itle
Startin# Salary & / ndin# Salary & /
8o( D$ties/ %esponsi(ilities0
Dates
mployed0
From 3o
%eason
"or
Lea'in#
May )e ,onta,t yo$r pre'io$s s$per'isor "or a re"eren,e* .S N/
APPLICANTS CERTIFICATION AND RELEASE
I ,erti"y that the "a,ts #i'en in my res$me and/or Appli,ation "or mployment are tr$e and ,orre,t. I $nderstand that i" employed+ any "alse
or misleadin# statements+ omissions+ or "ail$re to "$lly ans)er any re9$ested item on this appli,ation or on any do,$ment $sed to se,$re
employment shall (e #ro$nds "or re5e,tion o" this appli,ation or "or my termination "rom employment+ i" I am employed+ re#ardless o" )hen
s$,h in"ormation is dis,o'ered. I a$thori:e the Company to se,$re (a,-#ro$nd in"ormation on my )or- re,ord+ ed$,ation and other
matters related to my s$ita(ility "or employment. I a$thori:e my re"eren,es and (a,-#ro$nd so$r,es to dis,lose in"ormation a(o$t me to
the Company+ )itho$t #i'in# me prior noti,e o" s$,h dis,los$re. I here(y release the Company+ my "ormer employers and all other
so$r,es "rom any and all ,laims+ demands or lia(ilities arisin# o$t o" or in any )ay related to se,$rin# s$,h in"ormation or dis,los$res.
I $nderstand that nothin# ,ontained in the appli,ation+ or any in"ormation ,on'eyed d$rin# any inter'ie) )hi,h may (e #ranted+ or d$rin#
my employment+ i" hired+ is intended to ,reate an employment ,ontra,t (et)een me and the Company. I $nderstand that any employment
)ith this Company is ;at )ill+; )hi,h means that either I or the Company ,an terminate the employment relationship at any time )ith or
)itho$t prior noti,e+ and "or any reason not prohi(ited (y stat$te. All employment is ,ontin$ed on that (asis. I $nderstand that no
s$per'isor+ mana#er+ or e4e,$ti'e o" the Company has any a$thority to alter the "ore#oin# $nless a spe,i"i, term o" employment is in
)ritin# and si#ned (y the Company President/C/.
Si#nat$re Date
Edgebrook Club Employment Application
