Employment Application

PERSONAL INFORMATION:
Last Name:
First Name:
M.I.:
Date:
Address:
Unit/Apt:
City:
State:
Zip:
Phone:
Email:

EDUCATION:

Desired Wage:
Date Available to Start:
Position of Interest:
Position of Interest:
Are you currently employed?
May we contact your current employer?
Are you a citizen?
If not a citizen, are you authorized to work in the USA?
Have your ever worked for 10 High Country or 10 Park Lanes?
Have you ever been convicted of a felony?
Have you ever been convicted of a violent crime?
If yes, please list conviction and date:

EDUCATION:
High School:
Did you graduate?
College:
Dates:
Did you graduate?
Vocation/Trade School:
Dates:
Did you graduate?

College Students:
Will you be available to work when school is not in session, such as over holidays and breaks?
List below the days and times available to work. List only time you can work:
Sunday AM:
Sunday PM:
Monday AM:
Monday PM:
Tuesday AM:
Tuesday PM:
Wednesday AM:
Wednesday PM:
Thursday AM:
Thursday PM:
Friday AM:
Friday PM:
Saturday AM:
Saturday PM:

WORK HISTORY:
Current Employer:
Supervisor:
When did you work here?
Wage Rate:
Phone:
Reason for Leaving:
Did you give notice?
Job Description and Duties:

Employer:
Supervisor:
When did you work here?
Wage Rate:
Phone:
Reason for Leaving:
Did you give notice?
Job Description and Duties:

Employer:
Supervisor:
When did you work here?
Wage Rate:
Phone:
Reason for Leaving:
Did you give notice?
Job Description and Duties:

Please list any employers you do not wish to be contacted and why:

List any skills and or training that are specific to the job position(s) you are applying for:

Personal and Professional Character References:
1:
Phone:
Years known:
Relationship to you:
2:
Phone:
Years known:
Relationship to you:
3:
Phone:
Years known:
Relationship to you:

“I certify the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application are grounds for immediate dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by the President of the company. This wavier does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act (ADA) and other relevant federal and state laws. I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility document form upon hire.” We are an Equal Opportunity Company. We use the Predictive Index ™ questionnaire as part of the hiring process. You will be emailed a link to complete the assesment. Please complete within 24 hours to maintain the speed of process. Failure to complete will be deemed as no longer interested in the position.
Signature (Please enter your name):
Date: