Employment – The Blairmont Club

Name *

First

Last

Email Address *

Telephone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Position Applied For

Date Available *

Salary Expected *

Are you available for work... *

Full-Time
Part-Time
Shift

Hours Preferred *

Are you currently employed? *

Yes
No

Education

List any education, training or foreign launguage ability that may be relevant

Name of School

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Did you graduate?

Yes
No

Name of Secondary School

Secondary School Address

Address Line 1

Address Line 2

City

State

Zip Code

Did you graduate from secondary school?

Yes
No

Work Experience

Previous Employer 1 Name

Previous Employer 1 Phone

Previous Employer 1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Employer 1 Position / Title

Previous Employer 1 Supervisor

First

Last

Previous Employer 1 Dates Employed

Previous Employer 1 Reason for Leaving

Previous Employer 2 Name

Previous Employer 2 Phone

Previous Employer 2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Employer 2 Position / Title

Previous Employer 2 Supervisor

First

Last

Previous Employer 2 Dates Employed

Previous Employer 2 Reason for Leaving

Previous Employer 3 Name

Previous Employer 3 Phone

Previous Employer 3 Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Employer 3 Position / Title

Previous Employer 3 Supervisor

First

Last

Previous Employer 3 Dates Employed

Previous Employer 3 Reason for Leaving

Personal

List two references (not relatives or former employers)

Reference 1 Name *

First

Last

Reference 1 Phone *

Reference 1 Occupation *

Reference 1 Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference 2 Name *

First

Last

Reference 2 Phone *

Reference 2 Occupation *

Reference 2 Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you authorized to work in the United States? *

Yes
No

Have you ever been employed by the Blairmont Club? *

Yes
No

If yes, explain your previous employment

Can you perform the job functions required by the position sought? *

Yes
No

The Blairmont Club may require a medical examination after an offer of employment but before commencement of employment.

If not, please explain

Have you been convicted of a felony in the last 5 years? *

Yes
No

Criminal convictions are not a bar to employment, but will only be considered in relation to the specific requirements of the position sought.

If yes, please explain