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Employment Application
Personal Information
First Name
Middle Initial
Last Name
Address
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State
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AR
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DE
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DC
INTL
Zip
Home Phone
Cell Phone
Email
Are you 18 years or older?
Yes
No
Are you authorized to work in the United States?
Yes
No
Have you ever worked or gone to school under another name?
Yes
No
Have you ever been convicted of a crime?
Yes
No
*Answering yes does not disqualify you for employment, the nature of the offence will be considered
Position Applying For
Job Descriptions
-
Athletic Attendant
-
Bus Person
-
Dishwasher
-
Food Server
-
Line Prep Cook
Position Desired
Athletic Attendant
Busser
Dishwasher
Line Cook
Server
Date Available to Start
Desired Wage
Days Available
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Seeking Full Time or Part Time Employment
-
Full Time
Part Time
Can you work weekends?
-
Yes
No
Can you work nights?
-
Yes
No
Can you work overtime?
-
Yes
No
Are you a former Springhaven employee?
-
Yes
No
Did a Springhaven employee refer you?
Yes
No
Name of Employee
Education
High School Name
Did you graduate?
Yes
No
College Name
Area of Study
Did you graduate?
Yes
No
Technical School Name
Area of Study
Did you graduate?
Yes
No
Other Education or Training
Military Experience
Branch of service
Date of service
Rank at discharge
Job related training
Work Experience
Please list employment
beginning
with the most recent
Employer name and address - 1
Employer Name
Phone
Employer Address
City
Zip
Dates of Employment
Supervisor's Name
May we contact this employer?
Yes
No
What were your duties?
Employer name and address - 2
Employer Name
Phone
Employer Address
City
Zip
Dates of Employment
Reason for leaving
Supervisor's Name
May we contact this employer?
Yes
No
What were your duties?
Employer name and address - 3
Employer Name
Phone
Employer Address
City
Zip
Dates of Employment
Reason for leaving
Supervisor's Name
May we contact this employer?
Yes
No
What were your duties?
Reference Release and Verification
I certify that the information given herein is true, complete, and to the best of my knowledge, without any omissions. I understand that any false information or omission in this application or failure to comply with any of the conditions of employment contained in this application will be grounds for refusal or termination of employment and agree that The Springhaven Club shall not be liable in any respect if my employment is terminated for falsity of statements or omissions or failure to comply with the conditions of employment contained in this application.
I also hereby give the Springhaven Club the right to make a thorough investigation into my background, previous employment, education, and references in order to ascertain my suitability for employment. I authorize companies, persons, and schools to release my information regarding my employment and qualifications. I release from all liability and claims any and all companies, corporations, persons, and schools supplying any information whatsoever to representatives of the Springhaven Club. This includes and is not limited to parties with who I have entered into written or oral agreement which contains a confidentiality clause. I release, indemnify, and hold harmless the Springhaven Club, its officials, officers and employees from and against any and all liability which might result from conducting an investigation.
Applicant Signature
Date
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