Employment opportunity

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To print out an application

Ultimate Water Massage

EMPLOYMENT APPLICATION

We consider applicants for all positions without regard to race, color, Religion, gender, national origin, age, marital or veteran status,medical condition, disability, or any other legally protected status.

PLEASE PRINT

Position(s) Applied For		Date of Application
How Did You Learn About Us?
First Name Middle Name Last Name
Present Address City State Zip Code
Permanent Address City State Zip Code
Telephone Number(s)	Social Security Number \| \|		Are you 16 yrs of age or older? Y/N

Ø Have you ever filed an application with us before? Y/N If yes, date and location_________________

Ø Have you ever been employed with us before? Y/N If yes, date and location ________________

Ø Are you prevented from lawfully becoming employed in this country because of Visa or immigration status? (Proof of citizenship or immigration status will be required upon employment) Y/N

Ø Have you been convicted of a crime? Y/N If yes, list convictions_________________________

List 3 Personal References (professional relationship suggested) who are not related to you and are not previous employers.
Name, Occupation and Relationship	Address	Phone Number

Education	High School	Undergraduate College/University	Graduate
School Name/Location
Yrs Completed (Circle)	9 10 11 12	1 2 3 4	1 2 3 4
Diploma/Degree
Describe Course of Study (Honors, Specialized Training & activities)

Ø On what date would you be available for work?___________

Ø Are you available to work: Full-time Y/N Part-time Y/N

Ø Total hours available per week____________

Identify below the specific hours you are available to work per week (indicate am/pm).
	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
From
To

Ø List any extracurricular activities which might affect your schedule:___________________________________________________________________

Ø Are you presently employed? Y/N If yes, may we contact this employer? Y/N

If not employed, how long have you been unemployed? _____Yrs _____Months

Ø How many jobs have you had in the past 5 Yrs? _____

Ø Did you ever leave a job because you might have been fired if you did not quit? Y/N

Ø If yes, which jobs? __________________________________________________________

Ø In the past 5 years, how many times have you been fired or asked to resign?___

Please explain each situation ________________________________________________

Ultimate Water Massage EMPLOYMENT APPLICATION / CONTINUED

Start with your present or last job, and list in consecutive order the last 3 previous jobs held. Account for any time during this period that you were unemployed by stating the nature of your activities. Include any job-related military assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.
Employer			Dates Employed From \| To	Work Performed (Include promotions & achievements)
Address
Telephone Number(s)		Hourly Rate/Salary Starting\|Final
Job Title	Supervisor
Reason for Leaving		Hours worked weekly			Rrences checked by:_________

Employer		Dates Employed From \| To	Work Performed (Include promotions & achievements)
Address
Telephone Number(s)		Hourly Rate/Salary Starting\|Final
Job Title	Supervisor
Reason for Leaving		Hours worked weekly	References checked by:_________

Employer		Dates Employed From \| To	Work Performed (Include promotions & achievements)
Address
Telephone Number(s)		Hourly Rate/Salary Starting\|Final
Job Title	Supervisor
Reason for Leaving		Hours worked weekly	References checked by:_________

Please identify any other jobs, part-time and full-time, you have held in the past five years:

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at decision, including current and past an employment employment, education, and release from liability all persons, companies, corporations, and schools supplying that information. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Ultimate Water Massage 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 change is specifically acknowledged in writing by an authorized executive of this organization. Additionally, I understand that nothing contained in the employment application or in the granting of an interview is intended to create a contract between Ultimate Water Massage and myself for either employment or for the providing of any benefit arising from employment. In the event of employment, I understand that ay falsification or omission of information given in my application or interview(s), is immediate grounds for dismissal. I understand, also, that I am required to abide by all rules and regulations of Ultimate Water Massage.

Date_________ Signature of Applicant___________________________________

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