Employment Application

FEDERAL AND STATE LAWS PROHIBIT DISCRIMINATION IN EMPLOYMENT BECAUSE OF SEX, AGE, RACE, COLOR, RELIGIOUS CREED, MARITAL STATUS, SEXUAL ORIENTATION, NATIONAL ORIGIN, ANCESTRY, CITIZENSHIP, SERVICE IN THE ARMED FORCES OF THE UNITED STATES, DISABILITY, GENETIC INFORMATION, OR ANY OTHER PROTECTED CLASSIFICATION.

First Name

Last Name

Address

City

State

Zip

Home Phone

Cell Phone

Email Address

If under 18 years of age, can you provide required proof of your eligibility to work?

Yes

Are you legally authorized to work in the United States?
(You will be required to furnish proof of lawful work status if you are extended a job offer in accordance with the Immigration Reform and Control Act of 1986).

Yes

Have you filed an application with us before?

Yes

Have you worked for Belmont Country Club before?

Yes

If yes, when?

Name of Supervisor

Reason for Leaving

Pursuant to the Company's policy concerning work assignment, do you have any relatives employed by the Company?

Yes

If so, please state their name(s)

Employment Desired

Position(s) Applying For

Date Available

Do you desire full or part-time work?

Desired number of shifts per week?

Expected Rate?

List the days you are AVAILABLE to work
(It is not necessary for you to identify unavailability for work because of religious observance or practice).

Monday
(select all that apply)

Day

Evening

Tuesday
(select all that apply)

Day

Evening

Wednesday
(select all that apply)

Day

Evening

Thursday
(select all that apply)

Day

Evening

Friday
(select all that apply)

Day

Evening

Saturday
(select all that apply)

Day

Evening

Sunday
(select all that apply)

Day

Evening

Are you prohibited from or limited in your performance of any job duties for a Company by any restrictive covenants not to compete, confidentiality agreements or any other contracted obligations?

Yes

(If yes, please provide a copy of the agreement to

Highest Grade Completed

Highschool

College

Name of Last School Attended

License, Vocation or Trade Training

Course of Study

Graduation Date

References
List the names of 2 work related references we may contact and 2 personal references (not previous employers). Individuals with no prior work experience may list school or volunteer related references.

Work Reference 1

Work Reference 2

Personal Reference 1

Personal Reference 2

Employment History
List below your work experience (starting with your present or most recent employer) for the last five years or your last three employers, whichever will provide us with the greatest information about you. You may include as part of your employment history any verified work performed on a volunteer basis. Use the reverse side of the application form if you need additional space. Please account for all periods of unemployment in this section.

Dates Employed From - To

Name/Address/Telephone of Employer

Supervisor

Position

Reason Left

Dates Employed From - To

Name/Address/Telephone of Employer

Supervisor

Position

Reason Left

Dates Employed From - To

Name/Address/Telephone of Employer

Supervisor

Position

Reason Left

May we contact your present employer at this time?

Yes

IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.

APPLICANT'S STATEMENT
I have read and fully understand the questions asked in this application. I understand that this application is not an offer or contract of employment. If hired, I understand that any employment will be on a 90-day introductory basis and that my employment may be terminated with or without cause or notice, at any time, at either my option or that of Belmont Country Club. I understand that no management representative has any authority to enter into any agreement for continuing employment for any specific period of time or which is contrary to the foregoing without a written agreement signed by the General Manager/COO and me. I give Belmont Country Club permission to contact all or any of my previous employers and references and authorize them to provide all information requested of them by Belmont Country Club, and release and hold harmless all persons and entities from liability for doing so. I understand that any offer of employment is conditioned upon satisfactory references.

I have provided truthful and complete responses to all inquiries in the application and understand that the discovery of any falsification or omission constitutes a ground for immediate dismissal. If employed by Belmont Country Club, I will abide by its rules and regulations, which I understand are subject to change by the Company.

Date

Signature

* Bold Fields are Required

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Employment Application