Applicant Information Applicant first name Applicant last name Home Phone Cell phone Other Email Address Comments Employment Positions Are you applying for:   • Temporary work - such as summer or holiday work? YesNo   • Regular part-time work? YesNo   • Regular full-time work? YesNo If applying for temporary work, when will you be available? Can you work on the weekends? YesNo Can you work evenings? YesNo Are you available to work overtime? YesNo What days and hours are you available for work? Weekdays  From  To  Weekends  From  To  Monday  From  To  Tuesday  From  To  Wednesday  From  To  Thursday  From  To  Friday  From  To  Saturday  From  To  Sunday  From  To  Salary desired $ Personal Information Have you ever applied to / worked for Spring Mountain before? YesNo If yes, please explain (include date) Do you have any friends, relatives, or acquaintances working for Spring Mountain? YesNo If yes, state name & relationship If hired, would you have transportation to/from work? YesNo Are you over the age of 18? (If under 18, hire is subject to verification of minimum legal age.) YesNo If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? YesNo If hired, are you willing to submit to and pass a controlled substance test? YesNo Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation? YesNo If no, describe the functions that cannot be performed (Note: Spring Mountain complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.) Have you ever been convicted of a criminal offense (felony or misdemeanor)? YesNo If yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the case (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.) Education, Training and Experience High School: School name School address School city, state, zip Number of years completed Did you graduate? YesNo Degree / diploma earned College / University: School name School address School city, state, zip Number of years completed Did you graduate? YesNo Degree / diploma earned Vocational School: Name Address City, state, zip Number of years completed Did you graduate? YesNo Degree / diploma earned Military: Branch Rank in Military Total Years of Service Skills/duties Related details Additional Information Do you speak, write or understand any foreign languages? YesNo If yes, then what languages. Language 1 Language 2 Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us? YesNo If yes, please explain Employment History Are you currently employed? YesNo If you are currently employed, may we contact your current employer? YesNo Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment. Even if you have attached a resume, this section must be completed. Employer 1 Name of Employer Name of Supervisor Telephone Number Business Type Address City State Zip Length of Employment From:  to:  Position & Duties Reason for Leaving May we contact this employer for references? YesNo Employer 2 Name of Employer Name of Supervisor Telephone Number Business Type Address City State Zip Length of Employment From:  to:  Position & Duties Reason for Leaving May we contact this employer for references? YesNo References List below three persons who have knowledge of your work performance within the last four years. Please include professional references only. Do not list friends or relatives as professional references. First name Last name Telephone Number Address City State Zip Occupation City Number of Years Acquainted 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950 First name Last name Telephone Number Address City State Zip Occupation City Number of Years Acquainted 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950 Upload resume Upload your Resume (.doc or .pdf file format) 1 Mb maximum size of file Upload Please Read and Initial Each Paragraph, then Sign Below  I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.  I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.  I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation. Applicant's Signature Sep 07, 2010