Employment - The Breakers Hotel

Name*

First Last

Address*

Street Address City State / Province / Region

Email Address*

Phone*

Position Applying for ?*

How did you hear us ?*

Referred by*

Desired Pay Range*

Employment Desired

For which schedules are you available?

Available Start Date

Are you a citizen of the United States ?

Yes
No

Is English your first language ?

Yes
No

Have you ever been convicted of a felony ?

Yes
No

If yes, please explain in detail

Do you have a driver's license ?

Yes
No

Driver's License Number

State of Issue

Expiration Date

Have you ever been cited for driving under the influence of alcohol or any banned substance?

Yes
No

Education

Please indicate your highest level of education.

High School

High School Graduate?

Yes
No

High School Degree

Yes
No

College or University

College Graduate

Yes
No

Major / Subjects of Study

Diploma / Degree Name

Graduation Year

Are you legally able to work in the U.S.

Yes
No

Do you have a Social Security Card?

Yes
No

Have you been convicted of a crime in the past seven years?

Yes
No

If convited please describe.

References

Please list three professional references.

Reference 1

First Last

Relationship

Years Known

Company

Phone

Reference 2

First Last

Relationship

Years Known

Company

Phone

Work Experience

Are you currently employed?

Yes
No

Most Recent Employer

Date Started

Date Ended

Job Title

Supervisor

First Last

Phone

Starting pay

Final pay

Compensation

Address

Street Address Address Line 2 City ZIP Code State

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes
No

Previous Employment

Date Started

Date Ended

Job Title

Supervisor

First Last

Phone

Starting pay

Final pay

Compensation

Address

Street Address Address Line 2 City Zip Code State

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes
No

Skills and Qualification

Please enter any additional information or notes.

I certify that I have read and understand the applicant on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to a drug testing to detect the use of illegal drugs prior to and during employment.

*

I acknowledge that the information within this application is true and correct.

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