CLUB LOVELAND EMPLOYMENT APPLICATION

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General Information

Date

MM slash DD slash YYYY

The following information is requested to help us make the best possible placement of employees within the company and its affiliates. Complete all portions of the application pertaining to you. We appreciate the time you spend completing this application. We, in accordance with state and federal laws, do not discriminate on the basis of age, race, religion, color, sex, national origin, ancestry, mental or physical disability, or any other characteristic protected by law.

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Email(Required)

Phone(Required)

If hired, can you show proof of legal authorization to work in the United States of America?(Required)

Yes

No

What position are you applying for?(Required)

Membership TeamFront Desk/Customer ServiceJanitorial/CleaningChild CarePersonal Trainer

If hired, when can you begin work?(Required)

MM slash DD slash YYYY

Do you have any convictions as an adult?(Required)

Yes

No

If yes, please explain:

Education:

High School:

School Years Attended Major

College:

School Years Attended Major

Other:

School Years Attended Major

Most recent employment record

Please list employment history with the MOST recent to LEAST recent

From:

MM slash DD slash YYYY

To:

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Name of Employer

Employer Address

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Name of Supervisor

First Last

Supervisor Contact Number

Job Title & Responsibility

Reason for Leaving

Employment record #2

From:

MM slash DD slash YYYY

To:

MM slash DD slash YYYY

Name of Employer

Employer Address

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Name of Supervisor

First Last

Supervisor Contact Number

Job Title & Responsibility

Reason for Leaving

Employment record #3

From:

MM slash DD slash YYYY

To:

MM slash DD slash YYYY

Name of Employer

Employer Address

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Name of Supervisor

First Last

Supervisor Contact Number

Job Title & Responsibility

Reason for Leaving

Employment record #4

From:

MM slash DD slash YYYY

To:

MM slash DD slash YYYY

Name of Employer

Employer Address

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Name of Supervisor

First Last

Supervisor Contact Number

Job Title & Responsibility

Reason for Leaving

Employment record #5

From:

MM slash DD slash YYYY

To:

MM slash DD slash YYYY

Name of Employer

Employer Address

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Name of Supervisor

First Last

Supervisor Contact Number

Job Title & Responsibility

Reason for Leaving

Employment record #6

From:

MM slash DD slash YYYY

To:

MM slash DD slash YYYY

Name of Employer

Employer Address

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Name of Supervisor

First Last

Supervisor Contact Number

Job Title & Responsibility

Reason for Leaving

Employment record #7

From:

MM slash DD slash YYYY

To:

MM slash DD slash YYYY

Name of Employer

Employer Address

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Name of Supervisor

First Last

Supervisor Contact Number

Job Title & Responsibility

Reason for Leaving

Please Indicate the Employers we may NOT contact:

Employer:

Reason:

Employer:

Reason:

Employer:

Reason:

Employer:

Reason:

Please list any relevant special training, licenses, certificates you may have related to the position you are applying for.

List any job related professional associations in which you participate. DO NOT INCLUDE: associations that would identify your age, race, color, sex, national origin, citizenship, religion, veteran's status, or disabilities

Please list the times you are available to work for each day:

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

PLEASE READ ALL OF THE FOLLOWING BEFORE SUBMITTING

I certify that the information shown on this application is correct and complete to the best of my knowledge, and that I have not knowingly withheld any fact or circumstance. I understand that falsifying or omitting information on his form may cause me to be disqualified from further consideration or dismissed from employment if hired. All employment offers are made contingent upon satisfactory proof of legal authorization to work in the United States of America according to the law. I understand that failure to provide satisfactory proof of identity and authorization to work in the USA will disqualify me from employment.

I understand that, if hired, my status will be that of an employee at will, with no contractual right, expressed or implied, to remain employed. In consideration of my employment, I specifically agree that my employment may be terminated, with or without cause or notice, at any time, at the option of either the employer or myself. I understand that no one, other than the Operational Manager, in writing, may bind the company to any agreement for employment or make any agreement contrary to the foregoing.

I understand that if hired, I may be required to undergo a physical examination and drug and alcohol screening test either: If I should become involved in an accident while on duty, on company premises, on job sites, or in a company vehicle; or if a reasonable suspicion of drug or alcohol use exists based on my performance, appearance, and/or behavior. The examination and the test will be performed at the employer’s expense, by the employer’s choice of physician.

I authorize the employer to investigate, confirm, and supplement any information contained on this application and to contact former employers unless otherwise stated.

By checking this box, I certify that I have read and consent to the above information.(Required)

Yes, I have read and consent to the above.