Employment Application





APPLICATION INFORMATION 

We consider all applicants for positions without regard to race, color, religion, sex, national origins, citizenship, age, mental or physical disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.

First Name M. I.
Last Name 
Street Address:   Apartment/Unit #:  
City   State   Zip  
Phone No. Email
Date Available   Desired Salary  Position Applied for  

Are you a citizen of the United States?
 Yes   No
If no, are you authorized to work in the U.S.?
 Yes   No   
(Proof of eligibility will be required upon offer of employment
 

Have you ever been convicted of a felony? 
 Yes   No   
(A conviction will not necessarily disqualify you.

If yes, explain:   

Are you currently awaiting trial?
 Yes   No   
If you answered YES, to any of the previous questions, state the nature of the offense and disposition of the case. Include dates and places.

(Note: Felony convictions or the existence of a criminal record do not consitute an automatic bar to employment.

Are you 18 years of age or older?
 Yes   No
(If no, you maybe required to provide authorization.
Can you with or without reasonable accommodation perform the essential functions of this job?
 Yes   No  
(If you have any questions about the functions of the job, please ask the interviewer before answering this question.)
Have you ever applied to the Fort Wayne Country Club before?
 Yes   No  

If YES, please give date 
Have you ever worked for this company? 
 Yes   No  

If so, when?  
Are you currently on Payroll?
 Yes   No

Do you have any family that work at Fort Wayne Country Club?
 Yes   No  

If YES, please give name and relation to you 


EMPLOYMENT
Are you seeking

Type of Work desiredSalary desired
What hours and shift(s) would you prefer to work?


Please indicate any shift(s) you would not be available to work 
Are you willing to work overtime? 
 Yes   No


Are you willing to work weekends?
 Yes   No

Are you willing to work holidays? 
 Yes   No



Is there any information we would need about your name, or use of another name, for us to be able to check your work record? 
 Yes   No

If YES, please specify
 

Have you ever been discharged?
 Yes   No

If YES, please specify



How many days have you missed or been late from school or work within the last year other than approved vacation, sick or disability leave?
 
Please list any additional information that relates to your ability to perform the job for which you have applied, such as licenses, professional memberships, hobbies, etc.

EDUCATION
High School  
Address
From To Did you graduate? 
 Yes   No
Degree:  

College  
Address 
FromToDid you graduate?
 Yes   No 
Degree:  

Other 
Address   
From To   
Did you graduate?
 Yes   No

Degree   

REFERENCES
Please list three professional references.
Reference 1
Full Name   
Relationship   
Company  Phone No.   
Street Address      
City   State    Zip
Reference 2
Full Name   Relationship 
CompanyPhone No.  
Street Address       
City    State  Zip   
Reference 3
Full Name  Relationship   
Company   Phone No.   
Street Address       
City    State    Zip   
PREVIOUS EMPLOYMENT
Have you ever been fired or asked to resign from a job? 
 
If Yes, please explain
  

Begin with current or most recent employer. Do not exclude any employment. Include any applicable temporary employment-attach another sheet if necessary. Previous salary or wages will not be used to determine compensation at Fort Wayne Country Club.

Employment 1
Company  Phone No.  
Street Address       
City   State
Zip
Supervisor  
Responsibilities   
From  To   
Reason for Leaving   

May we contact your previous supervisor for a reference? 
Employment 2
Company   Phone No.
Street Address      
City    State 
Supervisor  
Responsibilities  
From  To
Reason for Leaving  

May we contact your previous supervisor for a reference? 
Employment 3
Company  Phone No. 
Street Address     
City    State 
Supervisor   
Responsibilities   
From   To   
Reason for Leaving  

May we contact your previous supervisor for a reference? 

MILITARY SERVICE
Branch  
From 
To
Rank at Discharge  Type of Discharge  
If other than honorable, please explain  

PLEASE READ CAREFULLY BEFORE SIGNING

I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the chief operating officer of this organization. I understand that this application is not a contract of employment. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment.

I understand this application will be active for a period of one year; after that time, if I wish to be considered for employment, I must submit a new application.

I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information.

I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations. I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a post-job offer physical examination and my employment will be conditional upon passing such examination.

I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.

Signature (provide initials)  Date  

Enter Verification Code   
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