Application for Employment

Lake Naomi Club is an equal opportunity employer and does not unlawfully discriminate in employment.
No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law.
Equal access to employment, services, and programs is available to all persons.
Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

PERSONAL INFORMATION

First Name: *

Last Name: *

Mailing Address Line One: *

Mailing Address Line Two: *

City: *

State: *

Zip: *

Cell Phone #:

Email Address:

EMPLOYMENT DESIRED

Type of employment desired:

	*Full-time
	*Part-time
	*Seasonal

Desired Position(s) *

Date you will be available to start:

Hours you are available:

If Seasonal Applicant - date you will be available to work until:

Have you ever been employed by Lake Naomi Club?

Yes

If yes, when?

If yes, position(s)?

How were you referred to us?

	Advertisement
	Friend
	Relative
	Other

If selected other please define:

Are you able to meet the attendance requirements?

Yes

Do you have any objection to working overtime if necessary?

Yes

Can you submit proof of legal employment authorization and identity?

Yes

IF you are under 18, can you furnish a work permit if it is required?

Yes

Have you ever been convicted of a crime?

Yes

If yes, please explain:

EMPLOYMENT HISTORY

Please provide all information pertinent to your past four employers beginning with the most recent.

Employer Name:

Employer Address:

Employer Phone Number:

Position:

Salary:

Start date of employment:

End date of employment:

Reason for leaving:

Employer # 2

Employer Name:

Employer Address:

Employer Phone Number:

Position:

Salary:

Start date of employment:

End date of employment:

Reason for leaving:

Employer # 3

Employer Name:

Employer Address:

Employer Phone Number:

Position:

Salary:

Start date of employment:

End date of employment:

Reason for leaving:

Employer # 4

Employer Name:

Employer Address:

Employer Phone Number:

Position:

Salary:

Start date of employment:

End date of employment:

Reason for leaving:

Educational Information

High School Name:

Years completed:

Course of study:

Degree(s) Earned:

College Name:

College Years completed:

College Course of study:

College Degree(s) earned:

Graduate School Name:

Graduate School Years completed:

Graduate School Course of study:

Graduate School Degree(s) earned:

Other Training or Workshop

Other Training or Workshop Name of school:

Other Training or Workshop Years completed:

Other Training or Workshop Course of study:

Other Training or Workshop Degrees earned:

THE FOLLOWING QUESTIONS NEED ONLY BE ANSWERED BY THOSE APPLYING FOR POSITIONS IN THE AQUATICS, RECREATION & SAILING DIVISIONS

Do you presently hold a Water Safety Instructor?s Certificate?

Yes

If yes, Expiration Date:

Do you presently hold a Lifeguard Training Certificate?

Yes

Do you presently hold a First Aid Certificate?

Yes

If yes, Classification:

Do you presently hold a U.S. Sailing Instructor?s Certificate?

Yes

What Sports, Hobbies or Skills could you teach to a group?

What is your favorite age group to work with?

REFERENCES

Give the names of three persons not related to you who you have known at least one year.

Reference #1 Name:

Reference #1 Address

Reference #1 Phone Number

Reference #1 Years Acquainted:

Reference #2 Name:

Reference #2 Address:

Reference #2 Phone Number:

Reference #2 Years Acquainted:

Reference #3 Name

Reference #3 Address

Reference #3 Phone Number:

Reference #3 Years Acquainted:

THE FOLLOWING QUESTIONS SHOULD BE ANSWERED BY ALL APPLICANTS

In the space provided below, please write brief statements which you feel may be helpful to us in considering the following:

(a) Why do you want to work on the staff team of the Lake Naomi Club?

(b) What benefit do you feel a position with the Lake Naomi Club will be to you?

(c) Describe any relevant extracurricular activities that you have been or are involved with?

Brief Statement:

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

The submission of this application signifies that I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.

Submit