San Juan Pools

Today's Date

mm/dd/yyyy

Date Available

mm/dd/yyyy

APPLICATION FOR EMPLOYMENT
All questions must be answered
carefully and completely.

Last Name

First Name

Middle Name

Address

Telephone
( )

City

State

Zip Code

Position Desired

Salary Desired

Type of Employment Desired:

Full Time

Part Time

Temp

Days Available:

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

Hours Available

Willing To Work Overtime? Yes No

Are you a Previous Applicant?
Yes No

Are you legally able to work in the U.S.?
Yes No

Are you over the age of 18?
Yes No

Are you able to perform any or all job functions with or without reasonable accommodation?
Yes No

Have you ever used Illegal Drugs?
Yes No

Have you used Illegal Drugs in the last 6 Mo?
Yes No

Have you ever been a Previous Employee?
Yes No

Have you ever been convicted of a felony or pled Nolo Contendere to a felony?
Yes No

If yes, describe conditions:

(Convictions will not necessarily disqualify an applicant for employment)

WORK EXPERIENCE
Start with most recent position, furnish dates and explanation for each period of employment for the past 10 years. Use separate sheet if necessary.

Present/Last Employer

Type of Business

Address

Telephone
( )

Start Date/Leave Date

Rate of Pay $
Weekly Bi-weekly Annual

Reason for Leaving

Job Title

Supervisor and Title

May We Contact?
Yes No

Describe Responsibilities

Previous/Last Employer

Type of Business

Address

Telephone
( )

Start Date/Leave Date

Rate of Pay $
Weekly Bi-weekly Annual

Reason for Leaving

Job Title

Supervisor and Title

May We Contact?
Yes No

Describe Responsibilities

Previous Employer

Type of Business

Address

Telephone
( )

Start Date/Leave Date

Rate of Pay $
Weekly Bi-weekly Annual

Reason for Leaving

Job Title

Supervisor and Title

May We Contact?
Yes No

Describe Responsibilities

Previous Employer

Type of Business

Address

Telephone
( )

Start Date/Leave Date

Rate of Pay $
Weekly Bi-weekly Annual

Reason for Leaving

Job Title

Supervisor and Title

May We Contact?
Yes No

Describe Responsibilities

EDUCATION AND TRAINING Please complete all appropriate items.
Type of School	Name and Location of School	Degree Earned	Major/Minor Fields of Study
High or Trade School		Diploma? Yes No
Business or Tech School		Diploma? Yes No
College(s)		Diploma? Yes No
Other Training (Explain)		Diploma? Yes No

REFERENCES: List 3 Business References (DO NOT LIST RELATIVES OR PERSONAL FRIENDS)
Name	Telephone	Address	Relationship
	( )
	( )
	( )

APPLICANT STATEMENT

PLEASE READ BEFORE ACCEPTING: The facts set forth in my application are true and complete. I authorize my former employers to furnish all information pertaining to my work record. I hereby release my former employers from all liability on account of furnishing such information. I understand that if employed, false statements, omissions or misleading statements on this application, regardless of the time they are discovered, shall be considered sufficient cause for dismissal. I also agree that my employer shall not be held liable in any respect if my employment is terminated because of such omissions or false or misleading statements. The Company is hereby authorized to investigate my employment history, including contacting employers listed and to verify my education and training.

Checking this box means you have read, accept and agree with the applicant statement above.