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Application for Employment

We consider applicants for all positions without regard to race, color, religion, gender, national origin, age, physical disability, marital or veteran status, or any other legally protected status.
Position(s) Desired:
Date:

How did you learn about us?

Advertising Friend Walk-in Employment Agency
FaceBook Relative Other

Personal Information?

First Name
Middle Name
Last Name
Street Address
City
 State
 Zip Code
Home Phone
Mobile Phone
Social Security Number
Email Address
List any friends or relatives currently working for our company.
Are you 18 years of age or older?
Do you have reliable transportation?
Have you ever been employed at any of our locations before?
if yes, which site?
Are you currently employed?
May we contact your present employer?
Are you legally eligible for employment in the USA and this state?
Are you willing to submit to a drug test?
Have you ever been convicted of a felony? (Conviction will not necessarily disqualify an applicant from employment)
if yes, Please explain the details of your conviction
Have you ever been terminated or asked to resign from any job?
if yes, please explain?

Education?

High School Name & Address
Course of Study
Years Completed
Dimploma/Degree
Undergrad College Name & Address
Course of Study
Years Completed
Dimploma/Degree
Graduate Professional Name & Address
Course of Study
Years Completed
Dimploma/Degree
Other(specify)
Course of Study
Years Completed
Dimploma/Degree

Availability?

(Please provide days and hours that you are available to work)

DaysFrom:To:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
On what date would you be available for work?
Do you prefer to work Full Time Part Time Either Temp

Employment Experiance

Start with your current or most recent job. Include any job-related military service assignment and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

EmployerDates Employed
Name & Address
From
To
Job Title Supervisor
Work PerformedHourly Rate/Salary
Starting
Final
Reason for Leaving
EmployerDates Employed
Name & Address
From
To
Job Title Supervisor
Work PerformedHourly Rate/Salary
Starting
Final
Reason for Leaving
EmployerDates Employed
Name & Address
From
To
Job Title Supervisor
Work PerformedHourly Rate/Salary
Starting
Final
Reason for Leaving
EmployerDates Employed
Name & Address
From
To
Job Title Supervisor
Work PerformedHourly Rate/Salary
Starting
Final
Reason for Leaving
EmployerDates Employed
Name & Address
From
To
Job Title Supervisor
Work PerformedHourly Rate/Salary
Starting
Final
Reason for Leaving

Pay rate desired

(Please list the salary range you are requesting)

References:

(Give name, address and phone number of three references who are not related to you )

Name and AddressPhoneRelationship & Years Known

Other Qualifications:

State any additional information you feel may be helpful to us in considering your application.

Applicant's Statement:

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I understand this application for employment shall be considered active for a period of time not to exceed 45 days. If I wish to be considered for employment beyond this time period, I should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such "at will" status is specifically changed in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Type your name in the Signature field below as your electronic signature.
Signature
 Date
Validation Code:
 
Form Validation


If you would like to also send us a resume, references, or any other written documents for us to consider, please complete this web page application first, and then fax those documents to: (703) 766-6178

® 2020 Lazer Xtreme Family Fun Center, a BusinessVentures.com company. Content by Rick Rahim.