application

MAID OF THE MIST CORPORATION
APPLICATION FOR EMPLOYMENT
1.
NAME AND LOCAL ADDRESS
First
M.I.
Street
Last
City
2.
REFERRED BY:
4.
ARE YOU AT LEAST 18 YEARS OF AGE?
First
State
3.
Last
Yes
No
Home Phone
ZIP
Cell Phone
ACTIVE MILITARY SERVICE:
From
To
New York State Law Against Discrimination prohibits discrimination because of age.
IF NOT, WHAT IS YOUR AGE?
5.
POSITION DESIRED:
7.
DATE AVAILABLE TO BEGIN:
9.
NOTIFY IN CASE OF EMERGENCY:
10.
6.
8.
AVAILABLE TO WORK UNTIL (DATE): Full Time First
M.I.
Yes
No
Part Time
Last
Telephone No.
EXCEPT FOR MINOR TRAFFIC VIOLATIONS, HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR?
IF “YES”, PLEASE EXPLAIN:
11.
AVAILABLE WEEKENDS:
YES
A “Yes” answer does not necessarily preclude employment.
EDUCATION Please select the last year of school you have completed.
K
7
1
2
8 9
3
10
4
11
5
12
6
Graduate
Yes
No
Major Subject
Credits
Degree Received
College
Other
Job-Related Skills
12.
NO
EMPLOYMENT List present and past employment for last 5 years (use “Applicant’s Remarks” space on back if additional space is needed.)
Employer
Address
Weekly
Salary
Employed From
To
Address
Weekly
Salary
Employed From
To
Address
Weekly
Salary
Employed From
To
Reason for Leaving
Explain Duties
Employer
Reason for Leaving
Explain Duties
Employer
Reason for Leaving
Explain Duties
ADM-35 2/86 10M
APPLICANT’S REMARKS:
PRE-EMPLOYMENT STATEMENT
I understand that the Company will not contact my present employer without my permission. I authorize the Company
to investigate other information in this application and to consult with any other individual or organization named in
this application. I authorize all named organizations to provide any information to the Company, and I release from all
liability, any individual or organization providing such information. If requested, I will execute a Fair Credit Reporting
Act Disclosure and Release so as to authorize the Company to obtain consumer reports from third parties on my
personal history and credit record.
I understand that if employed I am responsible for reviewing and understanding all Company policies, including the
Company’s code of business conduct and ethics. I also understand that if employed I will be required, subject to
applicable statutes and regulations, to work the hours (including overtime), the days (including weekends), and the
shift (day or night) scheduled by the management of the department in which I am employed.
I understand that employment with the Company is at-will and that if hired my employment can be terminated with or
without cause and with or without notice, at any time, at the option of either the Company or myself, and that the only
person authorized to alter my at-will status is the President of the Company in writing signed by the President.
I certify that I have read and understand this PRE-EMPLOYMENT STATEMENT and that all information in this
application is true and correct and without material omissions. I understand that any incorrect, incomplete or false
information given by me is sufficient cause to void this application and/or terminate my employment.
Date: ___________________
Signed: ________________________________________________
INTERVIEWER’S COMMENTS:
Interviewed by:
Date: