Employment Application - University Club of Washington DC

Applicant Information

Full Name:

Date:

First

M.I.

Last

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Email:

Date Available:

Social Security No.:

Desired Salary:

Position Applied For:

Are you a citizen of the United States:

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

Have you ever worked for this company?

Yes

No

If yes, when?

Have you ever been convicted of a felony?

Yes

No

If yes, explain:

No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

Education

High School:

Address:

From:

To:

Did you graduate?

Yes

No

Diploma:

College:

Address:

From:

To:

Did you graduate?

Yes

No

Degree:

Other:

Address:

From:

To:

Did you graduate?

Yes

No

Degree:

References

Please list three professional references

Full Name:

Relationship:

Company:

Phone:

Address:

Full Name:

Relationship:

Company:

Phone:

Address:

Full Name:

Relationship:

Company:

Phone:

Address:

Previous Employment

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason For Leaving:

May we contact your previous supervisor for a reference?

Yes

No

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason For Leaving:

May we contact your previous supervisor for a reference?

Yes

No

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason For Leaving:

May we contact your previous supervisor for a reference?

Yes

No

Military Service

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature

Equal Opportunity Employer

Company is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization.

Please Read and Initial Each Statement Below:

INITIAL

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

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I authorize The University Club of Washington, DC permission to examine my references, record of employment, education record, and any other information I have provided. In addition, I release The University Club of Washington, DC from any and all claims, demands, or liabilities arising out of, or in any way related to, such examination.

Signature:

Date: