Application Date
*
MM
DD
YYYY
Name
*
First Name
Last Name
Present Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Permanent Address (if different from above)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Cell
(###)
###
####
Email
Name(s) of any Relative(s) working for Colonial Club Senior Activity Center.
Please tell us how you learned about Colonial Club or who referred you.
Have you ever been convicted of any violations of the law or are subject pending charges?
*
(IN ACCORDANCE WITH THE LAW, PENDING CHARGES OR CONVICTIONS WILL NOT BE USED OR CONSIDERED FOR EMPLOYMENT PRACTICES UNLESS THEY ARE SUBSTANTIALLY RELATED TO CIRCUMSTANCES OF THE PARTICULAR POSITION. A BACKGROUND CHECK WILL BE CONDUCTED BEFORE EMPLOYMENT IS OFFERED.)
If Yes, please explain:
Position Desired
*
Date Available for Work
*
MM
DD
YYYY
Salary Desired
Are there any restrictions on your availability to attend work on a regular basis and/or work overtime?
*
If Yes, please explain.
Have you ever applied to Colonial Club?
*
If so, when?
MM
DD
YYYY
Were you offered employment?
High School
Date Completed
MM
DD
YYYY
Years Completed
1
2
3
4
Degree Earned
Date Completed
MM
DD
YYYY
Years Completed
1
2
3
4
Degree Earned
Date Completed
MM
DD
YYYY
Years Completed
1
2
3
4
Degree Earned
Date Completed
MM
DD
YYYY
Years Completed
1
2
3
4
Degree Earned
Date Completed
MM
DD
YYYY
Years Completed
1
2
3
4
Degree or Certification Earned
Major Course of Study
Minor Course of Study
Are you currently employed?
If yes, may we contact your present employer?
Employer Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Job Title
Immediate Supervisor
Phone Number
(###)
###
####
Full Name While Employed
Job Duties
Did you voluntarily terminate your employment?
Reason for Leaving
Employer Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Job Title
Immediate Supervisor
Phone Number
(###)
###
####
Full Name While Employed
Job Duties
Did you voluntarily terminate employment?
Reason for Leaving
List any achievements or activities that you consider relevant to your ability to perform the job for which you are applying, such as: awards received, memberships or offices held in professional organizations, licenses held, computer languages or software programs, foreign languages (proficiency in speaking and writing), etc.
Reference #1
First Name
Last Name
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Relationship
Years Acquainted
Phone
(###)
###
####
Reference #2
First Name
Last Name
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Relationship
Years Acquainted
Phone
(###)
###
####
Reference #3
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Relationship
Years Acquainted
Phone
(###)
###
####
In Case of Emergency Notify:
First Name
Last Name
Phone #1
(###)
###
####
Phone #2
(###)
###
####
I have agreed to submit this application by electronic means. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. By checking this box and typing my name below, I am electronically signing my application.
Please type your First and Last Name
Sex
Race/Ethnicity/Cultural Identity
How did you find out about the position?
