Employment Application – Xtreme Altitude

Personal Information

Email*

Date*

Name (Last, First)*

Street Address*

City, State, Zip Code*

Cell Phone # (or home # if you don't have a cell phone)*

How did you hear about us?*

Job Information

Position(s) applying for (check all that apply)*

Preschool gymnastics instructor
School age gymnastics instructor
Birthday parties/special events
Front Desk
Team coach (must have prior competitive coaching experience)

Expected pay rate?*

Days and times you are available to work?*

(Mornings -- 9am-Noon, Afternoons -- 2pm-5pm, Evenings -- 6pm-9pm)

What date can you begin working?*

Are you 16 years or older?*

Yes
No (if no, you may need to obtain a work permit)

If under 18, please enter your date of birth*

If over 18, please put N/A

Are you currently employed?*

Yes
No

Are you prevented from becoming lawfully employed due to Visa or immigration status?*

Yes
No

Have you ever been convicted of a felony?

Yes
No

Have you ever been convicted of any crime, including sex-related or child abuse related claims?

Yes
No

Do you have your own car or a dependable way to work?

Yes
No

Education

Name and location of high school (if not applicable, put N/A)*

Number of years completed*

Did you graduate?*

Yes
No

Name and location of college (if not applicable, put N/A)*

Number of years completed*

Did you graduate?*

Yes
No

Describe any special honors, awards, specialized training or certifications (if none, put N/A)*

Employment Experience

(please start with your present or most recent job)

How many previous jobs have you had? (select up to 4)*

Company Name (1)*

Name and phone number of immediate supervisor (1)*

Date started (1)*

Date ended (if applicable) (1)*

Please select one of the following (1)

I am no longer employed at this company and it is OK to contact my former supervisor
I am no longer employed at this company and it is NOT OK to contact my former supervisor
I am still employed at this company and it is OK to contact my supervisor
I am still employed at this company and it is NOT OK to contact my supervisor

Starting/Ending payrate? (1)*

Duties and responsibilites (1)*

Reason for leaving? (if applicable) (1)*

Company Name (2)*

Name and phone number of immediate supervisor (2)*

Date started (2)*

Date ended (if applicable) (2)*

Please select one of the following (2)*

I am no longer employed at this company and it is OK to contact my former supervisor
I am no longer employed at this company and it is NOT OK to contact my former supervisor
I am still employed at this company and it is OK to contact my supervisor
I am still employed at this company and it is NOT OK to contact my supervisor

Starting/Ending payrate? (2)*

Duties and responsibilites (2)*

Reason for leaving (if applicable) (2)*

Company Name (3)*

Name and phone number of immediate supervisor (3)

Date started? (3)*

Date ended (if applicable) (3)*

Please select one of the following (3)*

I am no longer employed at this company and it is OK to contact my former supervisor
I am no longer employed at this company and it is NOT OK to contact my former supervisor
I am still employed at this company and it is OK to contact my supervisor
I am still employed at this company and it is NOT OK to contact my supervisor

Starting/Ending payrate? (3)*

Duties and responsibilites (3)*

Reason for leaving (if applicable) (3)*

Company Name (4)*

Name and phone number of immediate supervisor (4)

Date started (4)*

Date ended (if applicable) (4)*

Please select one of the following (4)*

I am no longer employed at this company and it is OK to contact my former supervisor
I am no longer employed at this company and it is NOT OK to contact my former supervisor
I am still employed at this company and it is OK to contact my supervisor
I am still employed at this company and it is NOT OK to contact my supervisor

Starting/Ending payrate? (4)*

Duties and responsibilites (4)*

Reason for leaving (if applicable) (4)*

Personal Qualities

Describe the qualities you have that would make you a great addition to our team*

Understanding and agreement

Please initial or type your name as indicated below each statement.

I certify that the statements given on this application or during an interview are true and complete and I authorize investigation of same with exception of contacting my current employer if I have so requested in this document. I have read and agree to the above statement (initial in the box below)*

I understand that if I am hired that any false, incomplete or misleading information given herein or during an interview shall result in immediate termination. I have read and agree to the above statement (initial in the box below)*

Electronic signature (type your full legal name in the box below)*

Xtreme Altitude Gymnsatics is an EQUAL OPPORTUNITY EMPLOYER and does not discriminate against applicants or employees on the basis of race, color, gender, marital status, religion, national origin, age, veteran status, disability or any other basis prohibited by local, state or federal law. No question on this application is intended for or will be used for the purpose of limiting or excusing any applicant's consideration for employment.

References

Please submit three references, TWO of which must be professional.

I hereby authorize all references listed below to provide a full and honest assessment of my character to Xtreme Altitude Gymnastics (please type your name below)*

Reference #1 - Name, phone number and your relationship to the reference*

Reference #2 - Name, phone number and your relationship to the reference*

Reference #3 - Name, phone number and your relationship to the reference*