Salm Job Application 2016

We greatly appreciate your interest in our organization and assure that applicants are considered for all positions without regard to race, color, sex, age, religion, national origin, disability, marital, or veteran, status. Please note this application must be completed in its entirety and signed, in order to be considered for employment. information submitted on this application is subject to verification. Note: All new hires are required to submit documentation in accordance with the Immigration Reform and Control act of 1996.

Full Name:

First Name Last Name

Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Date of Birth *

- Month - Day Year

Are you at least 18 years of age? *

Yes No

Phone: *

- Area Code Phone Number

E-mail: *

Camp Preference *

Position Applying for: *

Date available to start: *

- Month - Day Year

Type of employment desired: *

Fulltime Part Time Summer Only

Wage desired? *

Highest Level of Education. If college, what degree of study do you hold? *

Tshirt size *

S M L XL XXL XXXL

Describe days and hours of availability: *

Are you willing to work evenings, weekends, and travel when required?

Yes No

Do you require special accommodations required by ADA? Type “No” if not applicable: *

Felony or Misdemeanor Convictions: Please describe in full detail. Does not disqualify you. Type "NA" if no offence occurred. *

Attest to not using illegal substances

Yes No

Attest that you do not maintain a history of loss or limitation of privileges or disciplinary actions that may lead to current or past adverse actions

Yes No

Attest that you do not present a risk management concern, including: malpractice actions, insurance cancellations, Medicare/Medicaid sanctions, and ethical violations.

Yes No

List any and all technical skills: *

Have you ever been convicted of any crime other than a minor traffic violation? Please Explain. *

In what year(s) did the offense take place. Type "NA" if no offence occurred: *

Copy of Drivers License: *

Resume: One Page Maximum: *

Upload Degree or Diploma: *

Upload teachers certification:

Upload Offer Letter *

If you would like direct deposit, Please upload a voided check:

Social Secuity Number: *

List Three References (2 professional, 1 personal): Name and Phone Number. Non-Family: *

I verify that the statements I have made here on this application are true and complete. I understand that if I am hired, any false or incomplete information in this application will provide grounds for discharge. *

"I Do."

I agree to provide and allow Shake-A-Leg Miami authorization to conduct reference checks and contact former employers: *

"I Do."

In consideration for my employment, I agree to abide by the rules and regulation of the company, which rules may be changed, withdrawn, added or interpreted any any time, at the company's sole option and without prior notice to me. *

"I Agree."

Signature *

Shake-A-Leg Miami

Attestation

End of Attestations