NOTE: PLEASE ASK IF YOU NEED ASSISTANCE COMPLETING THIS APPLICATION

INFORMATION
LAST NAME: / FIRST NAME: / MIDDLE IN:
PRESENT ADDRESS: / CITY: / STATE / ZIP:
HOME OR MESSAGE PHONE: / WORK: / E-MAIL:
SOCIAL SECURITY NUMBER: / WAGE/SALARY DESIRED?:
POSITION APPLIED FOR? / DATE AVAILABLE FOR WORK?
AVAILABLE: Days Evenings Nights / APPLYING FOR: Full time Part time Temporary
Will visa or immigration status prevent lawful employment? Yes No (Proof of right to work in the U.S. will be required if hired.)
Are you 18 years or older? Yes No (If no, employment is subject to minimum legal age requirements.)
Do you have a Non-Compete, Non-Disclosure, or other agreement that might restrict your employment with us? o Yes o No
Have you ever previously applied to or been employed by this company? o Yes o No If yes, when?
How did you learn about this position opening?
Were you known by any other name at any job or school listed on this application? What name(s)?
At which school(s)/employer(s) were you known by this other name?
EDUCATION
Name and Location of School / Years Completed / Did you graduate? / Degrees Received
High School
College
Trade
Business, or
Graduate school
SKILLS
Typing ____ wpm Ten-key Bookkeeping Receptionist #incoming lines ______Other ______
Supervision (yrs of experience) ______Proficient at : Excel Word Access PowerPoint Outlook
Foreign languages (fluent, good, fair)______
Indicate other skills related to the position you are seeking:
______

EQUAL OPPORTUNITY EMPLOYER

EMPLOYMENT RECORD (INCOMPLETE APPLICATIONS CANNOT BE ACCEPTED)

Please list your employment history below beginning with the most recent employer, include U.S. military service.

If currently employed, may we contact your employer? Yes No

Employer Type of business Telephone ( )

City State Fax: ( )

Job Title Supervisor Telephone ( )

Dates Employed: From To Reason for leaving Wage/Salary

Duties

Employer Type of business Telephone ( )

City State Fax: ( )

Job Title Supervisor Telephone ( )

Dates Employed: From To Reason for leaving Wage/Salary

Duties

Employer Type of business Telephone ( )

City State Fax: ( )

Job Title Supervisor Telephone ( )

Dates Employed: From To Reason for leaving Wage/Salary

Duties

Employer Type of business Telephone ( )

City State Fax: ( )

Job Title Supervisor Telephone ( )

Dates Employed: From To Reason for leaving Wage/Salary

Duties

I certify that the information given by me is true and complete to the best of my knowledge. I understand that if I am employed, the discovery that I gave false information during the application process may result in immediate dismissal.

I authorize the Inn at Cave B LLC, to investigate all statements contained in this application and to request information about me from previous employers, educational institutions, and references. I expressly authorize my previous employers to provide information and opinions concerning my work and work habits. Further, I release all parties and persons connected with any requests for information from all claims, liabilities, and damages for whatever reason, arising out of furnishing any information. If employed, I release the Inn at Cave B LLC from any liability for future references it may provide regarding my work history with the Inn at Cave B LLC.

I understand it cannot be guaranteed that my application will be considered for any or all open positions the Inn at Cave B LLC may have or that my application will be considered for any specific time.

In the event of employment, I understand that I am required to abide by all current and subsequently issued rules and regulations of the Inn at Cave B LLC and that my employment and compensation may be terminated, at any time, with or without notice, by either party.

Signature of Applicant Date

07/11

HAVE YOU SINCE YOUR 18TH BIRTHDAY EVER BEEN CONVICTED OR PLED GUILTY TO ANY FELONY OR MISDEMEANOR OTHER THAN FOR A MINOR TRAFFIC VIOLATION?
When completing this section, do not disclose information regarding convictions that have been judicially sealed, expunged, eradicated, impounded, or dismissed. Do not disclose information regarding juvenile court convictions or minor traffic violations. A conviction record does not automatically bar you from employment. All of the job-related circumstances surrounding convictions will be considered.
1. / FELONY:
2. / MISDEMEANOR:
3. / DO YOU CURRENTLY HAVE CHARGES PENDING?
4. / ARE YOU CURRENTLY ON PROBATION?
5. / IF YOU ANSWERED YES TO ANY OF THE QUESTIONS ABOVE, PLEASE EXPLAIN BELOW
If yes, list dates, location (city, state & county), violation(s) and outcome below
(Includes all criminal laws i.e. petty misdemeanors, misdemeanors, gross misdemeanors, felonies, ordinance violations, DWI/DUI/BW, etc.)
Charge Type:
(Felony/Misdemeanor) / Date(s) / Location
(City, State, Country) / Violation(s) and Outcome

DISCLOSURE AND AUTHORIZATION

Cave B Inn LLC, (the “Company”) will procure a consumer report and/or investigative consumer report on you in connection with your employment application. Intelius, a consumer-reporting agency, will obtain the report for the Company. Intelius is located at 500 108th Avenue NE, Suite 1660, Bellevue, WA 98004, and can be reached at (425) 974-6100.

The report may contain information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. The types of information that may be obtained include, but are not limited to: credit reports, social security number verification, criminal records checks, public court records checks, driving records checks, educational records checks, verification of employment positions held, personal and professional references checks, licensing and certification checks, etc. The information contained in the report will be obtained from private and/or public record sources, including sources identified by you in your job application or through interviews or correspondence with your past or present coworkers, neighbors, friends, associates, current or former employers, educational institutions or other acquaintances.

The nature and scope of any investigative consumer reports that may be requested is explained above. You are nonetheless entitled to request more information about the nature and scope of such reports by submitting a written request to Human Resources, The Inn at Cave B LLC, 344 Silica Road NW, Quincy, WA 98848. The Company is furnishing you with a summary of your rights under the Fair Credit Reporting Act in a form prescribed by the Federal Trade Commission.

AUTHORIZATION

I have carefully read and understand this notice and authorization form. By my signature below, I consent to the release of consumer and/or investigative consumer reports to the Company.

Employee Last Name ______First ______Middle ______

Other names you are known by (maiden name, etc.) ______

Present Address ______City/State/Zip______

Social Security Number ______

Driver’s License Number (if needed for position) ______

Date of Birth ______Gender ______

Signature______Date ______