Dominique Moceanu Gymnastics Center Application

Dominique Moceanu Gymnastics Center

& Carmen's Yoga Studio
Gymnastics, Camps, Yoga & More

Gymnastics Instructor Application for Employment

[Pre-Employment Questionnaire]

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap, or veteran status.

DMGC: 734 N Progress Drive Medina, Ohio 44256

Gym: 330-952-2767

www.dmgc-usa.com
Today's Date

MonthDayYear
Date
Full Name

First NameLast Name
Birthdate?
Full birthdate
Have you ever used another name?
Yes or No?
If yes, please state the full name you've used
Name
Are you over 18? Yes or No
Yes or No
Street Address
City
State
Zip Code
Home Phone
Mobile Phone
E mail address (print)
example@example.com
Position desired?
Gymnastics Coach, Office Staff, Yoga Instructor
Name and address of parent or guardian if applicant is a minor:
Parent Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell #
What prompted you to apply here?
Referral? Ad on indeed? Ad on social media? Friend?
What is your desired rate of pay?
Pay per hour
How many hours per week do you desire?
When can you start?
Give specific date
Have you ever been convicted of a crime that has not been expunged by the court, other

than a minor traffic offense? Yes or No
Yes or No
If yes, explain
Answering "Yes" does not constitute an automatic bar to employment. Such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be
If yes, please provide details (dates and location for all convictions)

MonthDayYear
Date
College School Name
Location
Course of Study
No. of Years Completed
Did You Graduate?
#2 COLLEGE SCHOOL
School Name
Location
Course of Study
No. of Years Completed
Did You Graduate?
Hours available to work: (8:30am-3:00pm/3:00pm-9:00pm)?
Mon.
Type in hours. Be specific.
Tues.
Type in hours. Be specific.
Wed.
Type in hours. Be specific.
Thur.
Type in hours. Be specific.
Fri.
Type in hours. Be specific.
Sat.
Type in hours. Be specific.
Sun.
Type in hours. Be specific.
Why would these hours work for you?
Be specific
Have you ever been dismissed from employment or laid off?
The safety of our students is a top priority. Teaching physical skills to children requires quick movements and spotting and lifting heavy children, sometimes while in awkward positions. Also, a necessary part of the job includes moving and adjusting gymnastics apparatus such as heavy mats, beams, and bars that could weigh quite a bit. Can you perform the job duties of the position?
Yes or No? If no, why not?
Please answer, and be specific.
Can you, after employment, submit verification of your right to work in the United States?
Yes or No?
Please answer
Check off areas you are currently certified in:
USAG Safety
Yes or No
First Aid Certified
Yes or No
CPR Certified
Yes or No
Any other certifications?
Yes or No
Please list any job related organizations, professional clubs societies or associations to which you belong. You may omit any that indicate your race, religion, national origin, national origin, sex, age, ancestry, etc.
Our hours vary from week to week and occasionally you may be asked to stay late, leave early, or come in and sub on your day off. Do you foresee any problems with this?
Yes or No
Would you like to work in the office in the future?
Please answer as we are always interested in training staff to be subs or part-time helping hands in the office when needed.
FORMER EMPLOYERS
List last three employers, starting with the most recent one first. If you do not have former employees, please provide three professional and/or character references.
Place of Employment #1
DATE MONTH/YEAR

MonthDayYear
Date
FROM
TO
NAME
Business Name of Employment + Contact Supervisor
WORK
Type of job
PHONE NUMBER
Of business
EMAIL
example@example.com
SALARY
or hourly wage (please answer)
POSITION
REASON FOR LEAVING
Yes or No. If no, why not?
Be specific
What did you like least?
Be specific
Place of Employment #2
DATE MONTH/YEAR

MonthDayYear
Date
FROM
TO
NAME
Name of Business + Contact Supervisor
WORK
PHONE NUMBER
EMAIL
example@example.com
SALARY
POSITION
REASON FOR LEAVING
Why?
What did you like least?
Place of Employment #3
DATE MONTH/YEAR

MonthDayYear
Date
FROM
TO
NAME
Business Name + Contact Supervisor
WORK
PHONE NUMBER
EMAIL
example@example.com
SALARY
POSITION
REASON FOR LEAVING
What did you like least?
If currently employed, may we contact your current employer? Which of these jobs did you like best?
Yes or No. If no, why not?
"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS
I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION
THEY MAY HAVE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY
DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.
I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE
REALIZING THIS IS A BUSINESS OF CHILDREN, I UNDERSTAND THAT BY SIGNING THIS I AM ALLOWING DOMINIQUE MOCEANU GYMNASTICS CENTER (DMGC) TO PERFORM VARIOUS BACKGROUND CHECKS.
Date

MonthDayYear
Today's Date
Signature

Clear
Additional Information for Instructors

Please detail your experience as a gymnast or cheerleader. Please start with your most recent training.
Please detail your experience as a gymnast, cheerleader, teacher, or coach. Provide details concerning the employment experience you detailed on the second page of this application. What groups or levels did you work with and what were your duties?
1.
2.
Describe in detail three drills or approaches that you would use with a group of 8-year- olds who were having trouble mastering a cartwheel:
1.
2.
3.
You have a group of 4 year olds that is not paying attention. What do you do?
Describe your greatest strength and weakness as a teacher:
Strength? Weakness?
Answer both here
Where you trained?
Name of Business
For how long?
List the hardest elements you can presently do on the following equipment:
Beam
Bars
Tumbling
Trampoline
Write lesson plans for a beginning gymnastic class for girls ages 3-5. Please be specific.
Beam
Trampoline
Tumbl Trak
Write lesson plans for a beginning gymnastic class for girls ages 6-12. Please be specific.
Beam
Bars
Tumbling
Trampoline
Tumbl Trak
Electronic Signture

Clear
Should be Empty:

Dominique Moceanu Gymnastics Center

FORMER EMPLOYERS

"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS

THEY MAY HAVE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY

I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE

REALIZING THIS IS A BUSINESS OF CHILDREN, I UNDERSTAND THAT BY SIGNING THIS I AM ALLOWING DOMINIQUE MOCEANU GYMNASTICS CENTER (DMGC) TO PERFORM VARIOUS BACKGROUND CHECKS.