Application for Employment - Lehigh Valley, PA

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Full Name

Social Security #
Address

Are you under 18
Yes No
City
If you are under 18, DOB
State
E-Mail
Zip
Phone
1 - ( ) - -
Date you can start
Alt. Phone
1 - ( ) - -
Position desired
Pay desired
Hours
Full Time Part Time
Referred by
Day and hours available to work:
  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
From
To

Have you ever been convicted? (Include all pleas of "no contest" and/or "guilty", excluding traffic violations)
Yes No
If Yes, give details: (a conviction will not necessarily disqualify an applicant for employment)

Are you physically able to perform the skills necessary to complete the duties of the job for which you are applying?
Yes No

If no, please explain
Have you ever been fired from a job or asked to resign? Yes No
If yes, give details
Whom can we notify in case of emergency? Name Phone
EDUCATION:
  Name and location of school Degree/Area of study Number of years
High School
College
Graduate School
Other

Special Activities (Civic, Athletics, Academics, etc. - exclude labor organizations, and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status)
Relevant Experience: Please list any training, skills, certifications (CPR / First Aid / Lifeguard), past teaching experiences, work with children or computer skills.
FORMER EMPLOYERS: (Start with the most recent one)
Company name
Supervisor
Address
Phone
Job title / Position
Wage $
Date (From/To)
Reason for leaving?
Describe duties and responsabilities


Company name
Supervisor
Address
Phone
Job title / Position
Wage $
Date (From/To)
Reason for leaving?
Describe duties and responsabilities


OTHER REFERENCES: (Do not list relatives)
Name Relationship Phone Known for how long?
Name Relationship Phone Known for how long?
Name Relationship Phone Known for how long?


We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

I understand and agree that Five Star Fitness & Aquatics, LLC shall administer background checks on new employees having sensitive positions including but not limited to those positions which (1) handle cash; (2) are responsible for facility security (3) have occasion to be alone with children. Background checks may be waived if the person has had significant previous experience with Five Star Fitness & Aquatics, LLC prior to acquiring a sensitive position. I understand and agree that employment is conditional upon the results of these checks. I certify that all information provided in this Application for Employment is true, correct and complete. I understand that any false or misleading information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any and all statements contained in this application.

I UNDERSTAND THAT NEITHER THIS APPLICATION NOR VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OR EMPLOYMENT OR GUARANTEE EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME AND THAT ANY SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE DULY AUTHORIZED REPRESENTATIVE OF THE EMPLOYER AND THE EMPLOYEE, IF EMPLOYED. I hereby release and hold Five Star Fitness & Aquatics, LLC from any and all claims whatsoever, including but not limited to personal injury, arising out of or relating to any non-work hour and/or non-work related recreational activity provided to employee by or on behalf of Five Star Fitness & Aquatics, LLC. I further understand and agree that if employed, the employment will be "at will", which means that either party, the employee or Five Star Fitness & Aquatics,LCC , may end the employment relationship at any time, for any reason, or for no reason.

I have read, understand, and by my signature, consent to these statements.

Signature (Please type your initials)