U-Club Employment Application

Name of current or most recent employer:

Employer Phone Number

Please enter a valid phone number.

Current or Most Recent Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your job title:

Briefly describe your job:

List skills acquired:

Immediate supervisor's name:

Reason for leaving:

Employment dates: From Date (MM/YY) To date

Rate of pay: Starting $ Final $

Name of previous employer:

Previous Employer Phone Number

Please enter a valid phone number.

Previous Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your job title:

Briefly describe your job:

List skills acquired:

Immediate supervisor's name:

Reason for leaving:

Rate of pay: Starting $ Final $

Employment date (MM/YY): From date to date

Name of previous employer:

Previous Employer Phone Number

Please enter a valid phone number.

Previous Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your job title:

Briefly describe your job:

List skills acquired:

Immediate supervisor's name:

Reason for leaving:

Employment dates: From date To date

Rate of pay: Starting $ Final $

It is our policy to promote equal employment opportunity to all qualified persons without regard to irrelevant characteristics, including: race, religion, ancestry, color, national origin, age, sex, marital status, familial status, student status, height, weight, arrest record, disability, military status, political orientation, sexual orientation, gender identity, gender identification or expression, source of income, or any other protected group status, in compliance with applicable federal, state and local laws, with or without reasonable accommodation.

Reference #1 Name

How known?

Years known:

Reference #1 Phone Number

Please enter a valid phone number.

Reference #2 Name

How known?

Years known:

Reference #2 Phone Number

Please enter a valid phone number.

Read carefully before signing.

"I certify that the information supplied by me in this application is true and complete to the best of my knowledge and authorize investigation of all statements contained herein, and the release of any and all relevant and lawful information that others may have pertinent to any position for which I may be considered, including former employers and references. I hereby release from all liability or responsibility all persons, companies or corporations furnishing or seeking such information for any damage which may result. I further understand that any misrepresentation, falsification or omission of facts by me in this application shall be grounds for discharge in the event that I am hired.

"I understand and agree that, if hired, my employment is for no definite period, and I retain the right to resign at any time for any reason with or without cause, and the Employer reserves this same right. I understand that no representative of the Employer can enter into any agreement to the contrary other than the President of the Board of Directors, and such agreement must be in writing."

Signature

Current Date

Date

U-Club Employment Application

Education

Employment History

Previous Employer #1

Previous Employer #2

References