Albuquerque Country Club
601 Laguna Blvd., SW
Albuquerque, NM 87104 (505) 247-4111 Human Recourses
PO Box 7278 Fax 243-5492 Ext. 106
Albuquerque, NM 87104 www.AlbuquerqueCountryClub.org
Application for Employment
(Please Print or Type)
It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, or other protected classification.POSITION(s) APPLIED FOR: / 1 / 2
Wage or salary desired? / $ / When can you start? (mm/dd/yyyy)
Name: / Date (mm/dd/yyyy)
Street: / Home Phone (###) ###-####:
City: / Cell Phone (###) ###-####:
State: / Zip:
Are you over 18 years old? Yes No / Have you worked here before? Yes No
Are you authorized to work in the U.S. on an unrestricted basis? Yes No
How did you learn of this opening?
Have you been told the essential functions of the job or have you been shown a copy of the job
description listing the essential functions of the job? Yes No
Can you perform these essential functions with or without reasonable accommodation? Yes No
Are there any hours, shifts or days you cannot or will not work?
Shift preferred: / Are you willing to work overtime
as required? Yes No
Part-Time:
Full-Time:
Have you ever been convicted of a felony? Yes No
(Conviction will not necessarily disqualify an applicant for employment.) If yes, describe conditions:
EDUCATION / NAME & LOCATION OF SCHOOL / YEAR
GRADUATED / MAJOR / DIPLOMA/
DEGREE
High School
College/Univ.
College/Univ.
Other Training/Education:
In addition to your work history, what other experiences, skills or qualifications would especially fit you for work with our Club?
WORK HISTORY May we contact your present employer? Yes No
Address: / Date Started:
City, ST Zip: / Date Left:
Starting Position: / Starting Salary:
Per Hr Wk Mo Yr
Position on Leaving: / Salary at Leaving:
Per Hr Wk Mo Yr
Supervisor’s Name:
Supervisor’s Title:
Description of Duties:
Reason for Leaving:
Previous Employer: / Telephone:
Address: / Date Started:
City, ST Zip: / Date Left:
Starting Position: / Starting Salary:
Per Hr Wk Mo Yr
Position on Leaving: / Salary at Leaving:
Per Hr Wk Mo Yr
Supervisor’s Name:
Supervisor’s Title:
Description of Duties:
Reason for Leaving:
Previous Employer: / Telephone:
Address: / Date Started:
City, ST Zip: / Date Left:
Starting Position: / Starting Salary:
Per Hr Wk Mo Yr
Position on Leaving: / Salary at Leaving:
Per Hr Wk Mo Yr
Supervisor’s Name:
Supervisor’s Title:
Description of Duties:
Reason for Leaving:
Previous Employer: / Telephone:
Address: / Date Started:
City, ST Zip: / Date Left:
Starting Position: / Starting Salary:
Per Hr Wk Mo Yr
Position on Leaving: / Salary at Leaving:
Per Hr Wk Mo Yr
Supervisor’s Name:
Supervisor’s Title:
Description of Duties:
Reason for Leaving:
APPLICANT'S CERTIFICATION AND AGREEMENT
I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Club to make an investigation of any of the facts set forth in this application.
I understand that employment at this Club is “at-will,” which means that either I or the Club can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager or executive of the Club, other than the president has any authority to alter the foregoing.
Date Applicant's Signature
ALBUQUERQUE COUNTRY CLUB
CONSENT TO PROCUREMENT OF BACKGROUND INFORMAITON
I understand that, as a condition of my consideration for employment with, Albuquerque Country Club or as a condition of my continued employment with Albuquerque Country Club, Albuquerque Country Club may obtain a consumer report that includes, but is not limited to, my creditworthiness or similar characteristics, employment and education verifications, social security verification, criminal and civil history, personal interviews, DMV records, and other public records and any other information bearing on my credit standing, credit capacity, character, general reputation, personal characteristics and trustworthiness.
I hereby authorize and consent to Albuquerque Country Club procurement of such a report. I understand that, pursuant to the federal Fair Credit Reporting Act, Albuquerque Country Club will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment with Albuquerque Country Club. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report.
Applicant’s Name (printed): / Date of Birth (mm/dd/yyyy)Street: / Social Security Number:
City: / Drivers License Number: / State:
State: / Zip:
Other Address where you have lived in the previous 7 years:
Street: / City: / State: / Zip:1.
2.
3.
Date Applicant's Signature