Job Application

Last:

First:

M.I.

Date:

Email Address:

Telephone:

ADDRESS:

Street:

City:

State:

Zip:

I have lived at this address for more than one year.

If not, please give your previous address:

Social Security #:

I am under 18.

I am legally eligible for employment in the United States.

(Any offer of employment is conditioned upon proof of employment authorization is required by federal law.)

In case of an emergency notify:

Name:

Address:

Telephone:

Position(s) applied for:

Rate of pay expected: Available to begin work:

Available:

Full-time

Part-time

Specify days/hours:

If hired, I would be able to perform all the functions of this position as listed in the Job Description.

Please describe, if you wish, how you would be able to perform, with or without any reasonable accommodation, the functions of the position for which you have applied:

I was previously employed by Crotched Mountain. Date:

BACKGROUND CHECK: As part of the application process, we require that you sign and have notarized a CRIMINAL RECORD RELEASE AUTHORIZATION FORM. We will use this release form to obtain from the appropriate State organization a record of any criminal convictions that you may have. This background check is required of us by the rules and regulations of the various states in which we operate and their authorized agencies.

EDUCATION:

High School - years completed

I received my high school diploma.

I received my GED.

Name of College:

No. of years completed:

College Major:

Degree:

Other Schooling

Where did you learn about Crotched Mountain and/or position Vacancy?

Crotched Mountain Employee Referral's Name:

How did this employee encourage you to apply for employment?

List experiences, skills, and/or qualifications which you feel could mutually benefit yourself and the Center in an employment situation:

REFERENCES: Give below the name of two persons not related to you who you have known at least one year:

Name	Business	Phone Number

EMPLOYMENT: List most recent employer first. Include U.S. Military Service.

Dates (Mo./Yr.)	Employer Name/Telephone	Salary	Position	Reason for Leaving
From To
From To
From To
From To

Use this space to Cut & Paste your cover letter into.

If you have your resume in a text format, you can Cut & Paste it here. We do ask that you bring a printed copy with you when you come to the interview.

PLEASE READ

You will be asked to sign this form if you are asked to come in for an interview.

I _______________, hereby certify that all statements made by me on this application and accompanying resume (if any) are true and correct to the best of my knowledge and belief, and that I have withheld nothing that would, if disclosed, materially affect the application unfavorably. I hereby grant Crotched Mountain permission to verify such statements and information. I understand that any misrepresentation or omission of information made by me during the recruitment process may be considered as sufficient cause for rejection of this application, or, if employed, termination.

I _______________, hereby authorize the release of my employment dates, evaluations of working performance, opinions and any other relevant information to Crotched Mountain or its agents. If applicable, this is to authorize the Register/ Placement Office to release my educational transcript and information in my placement records to Crotched Mountain. I hereby release all parties with such relevant information and Crotched Mountain from any liability on account of such disclosure.

I acknowledge that this application is not, and is not intended to be a contract of employment. I understand that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time.

DATE:______________________ SIGNATURE:_____________________________

rev. 8/96