EMPLOYMENT APPLICATION

Windsor Great Park Recreation Association
Employment Office
P.O. Box 2126
Newport News VA 23609 / CONTROL NO.
POSITION APPLIED FOR / TYPE OF EMPLOYMENT
FULL TIMESUMMER
CO-OPTEMPORARY / DATE
NAME OF APPLICANT - LAST NAME / FIRST NAME / MIDDLE INITIAL(S)
HOME ADDRESS (NUMBER, STREET, CITY, STATE, AND ZIP CODE)
MAILING ADDRESS IF DIFFERENT FROM HOME ADDRESS (NUMBER, STREET, CITY, STATE, AND ZIP CODE)
SOCIAL SECURITY NUMBER / HOME TELEPHONE NUMBER
() / BUSINESS TELEPHONE NUMBER
() / E-MAIL ADDRESS
HIGH SCHOOL NAME AND LOCATION (FOR GENERAL EDUCATION DEVELOPMENT (GED) LIST CITY/STATE OF AWARD) / HIGHEST GRADE COMPLETED SUCCESSFULLY
9101112 / DID YOU GRADUATE?
YES NO
DO YOU HAVE A GED?
YES NO
UNIVERSITY/COMMUNITY COLLEGE ATTENDED AND LOCATION / YEARS COMPLETED
1234 / DID YOU GRADUATE?
YES NO / DEGREE(S), MAJOR, CERTS. EARNED
MAJOR SUBJECTS OF SPECIALIZATION
EMPLOYMENT HISTORY (ACCOUNT FOR ALL PERIODS OF MILITARY SERVICE AND UNEMPLOYMENT)
LIST ALL JOBS HELD DURING THE PAST TWO YEARS; BEGIN WITH THE MOST RECENT.
ALL INFORMATION IS SUBJECT TO VERIFICATION
EMPLOYED BY / DATES
(MO/YR) / BASE PAY
(40-HOUR WEEK) / JOB TITLES AND DUTIES
COMPANY / FROM / START
$PER
ADDRESSSTREETCITY / TO / END
$PER
STATE / ZIP CODE / SUPERVISOR / TOTAL MONTHS / REASON FOR TERMINATIONVOLUNTARY LAYOFF DISCHARGE
EXPLAIN:
COMPANY / FROM / START
$PER
ADDRESSSTREETCITY / TO / END
$PER
STATE / ZIP CODE / SUPERVISOR / TOTAL MONTHS / REASON FOR TERMINATIONVOLUNTARY LAYOFF DISCHARGE
EXPLAIN:
COMPANY / FROM / START
$PER
ADDRESSSTREETCITY / TO / END
$PER
STATE / ZIP CODE / SUPERVISOR / TOTAL MONTHS / REASON FOR TERMINATIONVOLUNTARY LAYOFF DISCHARGE
EXPLAIN:

WGPRA IS AN EQUAL OPPORTUNITY EMPLOYER U.S. CITIZENSHIP IS REQUIRED FOR MOST POSITIONS

EMPLOYMENT APPLICATION

Page 2 of 2

LIST THREE WORK-RELATED REFERENCES (DO NOT INCLUDE RELATIVES)MAY WE CONTACT YOUR CURRENT EMPLOYER? YES NO
FULL NAME / COMPLETE ADDRESS / TELEPHONE NO. / OCCUPATION AND EMPLOYER / YEARS
KNOWN
HOME ()
WORK ()
HOME ()
WORK ()
HOME ()
WORK ()
HAVE YOU EVER BEEN EMPLOYED BY WINDSOR GREAT PARK?
YES NO / IF YES, WHEN / IF YES, LIST EMPLOYEE NUMBER
ARE YOU 18 YEARS
OF AGE OR OLDER?
YES NO / ARE YOU A
U.S. CITIZEN?
YES NO / IF NO, CAN YOU PROVIDE PROOF THAT YOU HAVE THE LEGAL RIGHT TO WORK IN THE U.S.?
YES NO / ARE YOU ALSO A CITIZEN OF ANOTHER COUNTRY?
YES NO
BRANCH OF MILITARY SERVICE / DATES OF SERVICE
FROM: TO: / HIGHEST RANK HELD / TYPE OF DISCHARGE
HONORABLE GENERAL
OTHER / GS RATING
ARE YOU A CERTIFIED LIFEGUARD?
YES NO / ARE YOU RED-CROSS CERTIFIED IN FIRST AID?
YES NO
EXPERATION DATE: / ARE YOU RED-CROSS CERTIFIED IN CPR?
YES NO
EXPERATION DATE: / ARE YOU RED-CROSS CERTIFIED IN INFANT CPR?
YES NO
EXPERATION DATE: / DO YOU HAVE A CURRENT FOOD HANDLERS CARD?
YES NO
EXPERATION DATE:
HAVE YOU EVER BEEN CONVICTED YESNO
OF A CRIME ?
HAD A TRAFFIC CITATION WHICH YES NO
WAS OVER $200? / DATE / PLACE / OFFENSE / DISPOSITION (USE BLANK PAPER IF REQUIRED)
Because of the critical nature of Windsor Great Park Recreation Association (WGPRA) and our concern for the quality of our concession products, the health and safety of our members, guests, and employees, it is the policy of Windsor Great Park Recreation Association to not hire persons who use illegal drugs. For this reason the organization reserves the right for pre-employment, post-offer medical examinations that include a test for the presence of illegal substances, if detected the employment process will be stopped and/or employment terminated.
I hereby certify that the statements and answers given by me to the questions on this application, including representations in my resume, if given, are true and correct to the best of my knowledge, and have been made with no mental reservations whatsoever. If I receive a job offer from WGPRA, I agree to submit to a medical examination and I understand that my subsequent employment will depend upon the results of this examination. I also authorize my former employers to release to WGPRA any information they may have regarding my employment history with them. If, upon investigation, anything contained in this application is found to be untrue, I understand that I will be subject to dismissal at any time during the term of my employment by WGPRA.
SIGNATURE OF APPLICANT / DATE
DO NOT WRITE BELOW THIS LINE
APPLICANT HAS BEEN BRIEFED Date of Hire: Rate Of Pay:
ON ESSENTIAL JOB FUNCTIONS

Date of Termination:Reason for Termination:

INTERVIEWER’S COMMENTS