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Employment Application

If you are interested in joining a team that strives to have a positive influence on the community by exemplifying Honor, Integrity, Teamwork, and Service please fill out the following application. We always are accepting applications for Instructors, Coaches, and Customer Service Personnel. If you have any questions please give Ricky Scruggs a call at 440-4487.

Applicant Information

Please provide your full name in the name field.

Name *
E-mail Address *
Today's Date: *
Street Address: *
City:
State: *
Z!P Code: *
Phone Number: *
Date Available: *
Social Security No.: *
Desired Salary: *
Position Applied for: *
Are you a citizen of the Unites States? *
If no, are you authorized to work in the U.S.?
Have you ever worked for this company? *
If so, when?
Have you ever been convicted of a felony? *
If yes, explain:
High School name(s). Please list city and state location. If more than one list most recent first. *
Did you graduate? *
College name(s). Please list city and state location. If more than one list most recent first. As well as dates you attended.
Did you graduate?
Degree:
Other Education:
Did you graduate?
Degree:
Professional Reference #1. Full Name: *
Relationship: *
Company: *
Phone Number: *
Address: *
Professional Reference #2. Full Name: *
Relationship: *
Company: *
Phone Number: *
Address: *
Professional Reference #3: Full Name: *
Relationship: *
Company: *
Phone Number: *
Address: *
Previous Employment (list most recent first)
Employer #1 Name:
Phone Number:
Address:
Supervisor Name:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Date Started:
Date Ended:
Reason for Leaving:
May we contact your previous supervisor for a reference?
Employer #2 Name:
Phone Number:
Address:
Supervisor Name:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Date Started:
Date Ended:
Reason for Leaving:
May we contact your previous supervisor for a reference?
Employer #3 Name:
Phone Number:
Address:
Supervisor Name:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Date Started:
Date Ended:
Reason for Leaving:
May we contact your previous supervisor for a reference?
Military Service Branch:
Date Started:
Date Ended:
Rank at Discharge:
Type of Discharge:
If other than honorable, please explain:
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. *	No Yes

* Fields marked with an asterisk are required fields

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