Post on 13-Apr-2018
Yes No
Will you work overtime if asked?
Yes No Yes No
Yes No
Yes
No
Yes
No
Yes
No
Do you have a family member (parents, spouse, brother, sister, son, daughter, father or mother-in-law, brother or sister-in-law, son or daughter-in-law) who serves on Life Time’s Board of Directors?
FirstLast Name
DID YOU GRADUATE?
COURSE OF STUDY
Pay Expected
Street Address
City, State, Zip
Home Phone
Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, or handicap.
Please fill in both sides of applicationAPPLICATION FOR EMPLOYMENT
Alternate PhonePERSONAL
When will you be available to begin work?
Middle Date
NO. OF YEARS COM-
PLETED
Are you legally eligible for employment in the United States?
If Yes: Month _______ Year_______
If not, what hours can you work?
Apart from absence for religious observances, are you available for full-time work?
EDUCATION
SCHOOL
College
High
Elementary
Please list other special training or skills that you believe qualify you for the position.
DEGREE OR DIPLOMANAME AND LOCATION OF SCHOOL
MEMBERSHIP IN PROFESSIONAL OR CIVIC ORGANIZATIONS(Exclude those which may disclose your race, color, religion, or national origin.)
Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged, or sealed by a court? Yes No If Yes, describe in full.
State names of relatives and friends working for us other than your spouse.
Besides the local newspaper, where have you looked for job openings?
Have you ever been interviewed for employment with us?
Position Desired How did you hear about our agency?
Position:
4/09, 10/12, 2/13, 08/17
Reason for Leaving
To
Weekly Pay
Start Last
Address
State Job Title, and Describe Your Work Reason for Leaving
Company Name
Address
State Job Title, and Describe Your Work
Your Name While Employed
State Job Title, and Describe Your Work Reason for Leaving
Company Name
EMPLOYMENT HISTORYPlease give accurate, complete full-time and part-time
employment record. Start with present or most recent employer.
1
Phone Number
Employed (State Month and Year)
From
Name of Supervisor
Company Name
State Job Title, and Describe Your Work
Start Last
Name of Supervisor
Reason for Leaving
Address
Your Name While Employed
Weekly Pay
2
Phone Number
Employed (State Month and Year)
From To
Weekly Pay
Name of Supervisor
Phone Number
Employed (State Month and Year)
From To
Your Name While Employed3
Company Name
Phone Number
4 Name of Supervisor Your Name While Employed
Start Last
Start Last
Address
Employed (State Month and Year)
From To
Weekly Pay
Phone #
List 3 References other than family members or former employers.Name
Address
Phone #
Name
Address
Address
RE F ERENCE
We may contact the employers listed above unless you indicate those you do not want us to contact.
DO NOT CONTACTEmployer Number(s): Reason:
Phone #
Name
4/09, 10/12, 2/13, 08/17