Employment Application For Employment (Pre-employment Questionnaire) (An Equal Opportunity Employer) Personal Information * First Name: * Last Name: * Street Address: * City: * State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY DC INTL * Zip: * Phone Number: * Email Address: * Are you 18 years or older? YesNo Employment Desired * Desired Location (Can select more than one club): Kinsale Golf and Fitness Club Scioto Reserve Country Club * Availabilty: Full TimePart Time * Hours Available: * Department (Select all that apply): Aquatics Fitness Areas Group Ex. Instructor Housekeeping Kid's Club Locker Room Personal Training Restaurants/Events/Concessions Golf / Proshop Turf Maintenance Spa Services Welcome Desk * Specific Position: * Date You Can Start: * Are You Currently Employed? YesNo If Yes, Who is Your Current Employer? * Have You Ever Applied or been Employed by One of Our Clubs Before? YesNo If Yes, Which? Kinsale Golf & Fitness Club Scioto Reserve Golf & Athletic Club Education * High School: * # of Years Attended: Field of Study: * Graduated? YesNo * College: * # of Years Attended: * Field of Study: * Graduated? YesNo * Trade, Business, Correspondence or Military: * # of Years Attended: * Field of Study: * Graduated? YesNo Special Skills Or Certifications WSI Expiration Date: CPR Expiration Date: First Aid Expiration Date: Other Expiration Date: Group Exercise Expiration Date: Personal Training Expiration Date: Former Employers List Below your last three employers, starting with the most recent first. Employer 1 From: To: Name of Employer: Pay Rate: Position: Reason for Leaving: Employer 2 From: To: Name of Employer: Pay Rate: Position: Reason for Leaving: Employer 3 From: To: Name of Employer: Pay Rate: Position: Reason for Leaving: References Give the names of three people not related to you, whom you have known for at least one year Reference 1 Name: Address: Business: Phone: Years Acquainted: Reference 2 Name: Address: Business: Phone: Years Acquainted: Reference 3 Name: Address: Business: Phone: Years Acquainted: Physical Record Do you have any physical limitations that preclude you from performing any work for which you are being considered? YesNo If yes, what can be done to accommodate the limitation? Criminal Record * Have you at any time been convicted, in other than juvenile court, of a felony of misdemeanor other than minor traffic violations? A criminal record does not constitute automatic bar to employment, but will be considered in terms of the work to be performed. Failure to disclose a criminal conviction will result in termination. YesNo * If yes, please give the date(s), city, offense and disposition: “I certify that the facts contained in this application are true and completed to the best of my knowledge and understand that, if employed, falsified information on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I give Premier at Sawmill permission to seek a copy of my arrest record from the Franklin County Sheriff’s Office. I do hereby release the Franklin County Sheriff’s Office and all individuals connected therewith from all liability. I understand and agree that, if hired, my employment is for no definite period and may, regardless of date of payment of my wages and salary, be terminated without any prior notice.” * I certify the statement above? * Denotes Required Field Saving Information...Please Wait