Employment Application


Name (First, MI, Last)
Date:
Address
City/State
Zip Code:
Primary Phone No.
Email
Alternate Phone No.
Are you legally eligible to work in the U.S.?
Have you applied to QLLA/The Quechee Club before?
If yes, please provide the dates applied:
Have you ever worked for QLLA/The Quechee Club before?
If yes, please provide the dates applied:
Are you related to anyone currently employed by QLLA/Quechee Club?
If Yes, Name and Relationship:
How did you hear about us?
Quechee Club Member
Other

PositionCollapse

Position(s) applied for:
Are you seeking:
Date available to begin work?
Desired Salary or Rate of Pay? ($ _ per_)
Driving Record
(Answer only if driving is a requirement of the job for which you are applying)
Do you have a valid driver's license?
State
License No.
Are you able to operate a standard transmission vehicle?

EducationCollapse

High School
Name & Address of School
Number of Years Completed
Course of Study     
Diploma/Degree Received
College
Name & Address of School
Number of Years Completed
Course of Study     
Diploma/Degree Received
Graduate
Name & Address of School
Number of Years Completed
Course of Study     
Diploma/Degree Received
Other:

Training CoursesCollapse

(List any relevant training programs completed)
Course/Seminar
Org. Sponsoring
Content
Dates Attended
Course/Seminar
Org. Sponsoring
Content
Dates Attended

Special SkillsCollapse

List an academic honors, scholarships, professional memberships, offices held, etc. (Do not list any which reflect your race, color, religion, gender, national origin, age, disabilities or veteran status)

List an academic honors, scholarships, professional memberships, offices held, etc.

Employment ExperienceCollapse

(Include all types of employment starting with current or most recent)

Company

Dates Employed

From (MM/YY)
To (MM/YY)
Address:
Telephone:

Hourly Rate/Salary

Starting
Final
Job Title
Supervisor
Reason for Leaving
Description of Duties:

Employment ReferencesCollapse

(List 1 person not related to you, whom have known you for at least 1 year)

Name:
Telephone:
Company:
Address:
Relationship:
How long known?

Applicant Acknowledgement & AuthorizationCollapse

Please Read Carefully Before Signing this Form

 

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge.  I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee employment.  I further understand that, should an offer of employment be extended by QLLA/The Quechee Club that such employment with QLLA/The Quechee Club is at will, for no specified duration and may be terminated by either QLLA/The Quechee Club or myself at any time, with or without cause or notice.  I understand that none of the documents, policies, procedures, actions, statements of QLLA/The Quechee Club or its representatives used during the employment process is deemed a contract of employment real or implied.  I understand that no representative of QLLA/The Quechee Club except the Hiring Manager has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the Hiring Manager of QLLA/The Quechee Club.

In consideration for my employment, I agree to abide by the rules and regulations of QLLA/The Quechee Club, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me.

I understand that if offered a position with QLLA/The Quechee Club, I may be required to submit to a pre-employment medical examination, drug screening and/or background check as a condition of employment.  I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.

I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to QLLA/The Quechee Club and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.  I understand that this application is considered current for three months.  If I wish to be considered for employment after this period I must fill out and submit a new application.

BY SIGNING BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.

Signature
Date

QLLA/The Quechee Club is proud to be an EQUAL OPPORTUNITY EMPLOYER.  All qualified applicants will receive consideration without regard to race, color religion, gender, national origin, age, disability, veteran status or any other status protected by Law.