Employment Application

Hermitage Country Club, Inc. does not discriminate against applicants or employees because of their age, race, color, religions, national origin, sex, or any other basis prohibited by law. Furthermore, Hermitage Country Club, Inc. will not discriminate against any applicant or employee because he or she is mentally or physically disabled provided he or she is qualified and meet the requirements established by Hermitage Country Club, Inc.

Personal Information

First Name

Last Name

Middle Name

Street Address

City

State

Postal Code

Phone Number

Email Address

Are you 18 years old or older?

Yes

If not, state your date of birth:

Are any of your relatives members at Hermitage CC?

Yes

If yes, how are you related?

Type of Position Desired

Position applied for:

Full Time

Part Time

Seasonal

Temporary

Date available:

Have you ever worked for Hermitage Country Club, Inc?

Yes

If yes, when and in which department?

Have you ever applied to Hermitage Country Club, Inc?

Yes

If yes, when?

To comply with the Immigration Reform and Control Act of 1986, if you are hired you will be required to provide documents to establish your identity and your authorization to be employed in the United States. Such documents will be required before your first day of hire.

How were you referred to Hermitage Country Club, Inc?

Are you willing to take a pre-employment drug test?

Yes

Have you ever been convicted of a crime (misdemeanor or felony)?

Yes

If yes, explain:

(Disclosure of a criminal record will not necessarily disqualify you for employment. Each conviction will be evaluated on its merits with respect to time, circumstances and seriousness, in relation to the job for which you are applying.)

Education - High School

Name, Address of School & Dates Attended:

Graduated?

Yes

Education - College/University

Name, Address of School & Dates Attended:

Graduated?

Yes

Type of Degree/Diploma received or expected:

Major/Minor Fields of Study:

Education - Other

Name, Address of School & Dates Attended:

Graduated?

Yes

Type of Degree/Diploma received or expected:

Major/Minor Fields of Study:

General

Do you possess a valid current driver's license (only for jobs that require driving a vehicle)?

Yes

Driver's license number and state

Military Service

Have you ever been a member of the armed forces of the United States?

Yes

If yes, list any special skills or abilities you developed while in the military service which directly relate to the job for which you are applying.

Experience - Most Relevant Only

Name and Address of Employer:

Starting Position:

Ending Position:

Phone:

Name & Title of Supervisor:

To:

Reason for Leaving:

May we contact this employer?

Yes

Use this space to describe any previous work history and/or to detail particular job responsibilities listed above. Include any additional information which you feel may be relevant to the job for which you are applying.

Additional Experience

Name and Address of Employer:

Starting Position:

Ending Position:

Phone:

Name & Title of Supervisor:

From:

To:

Reason for Leaving:

May we contact this employer?

Yes

References

(Individual Familiar With Your Work Ability - Do Not Include Relatives)

Reference 1

Name:

Address:

Phone Number:

Years Known/ Relationship

Reference 2

Name:

Address:

Phone Number:

Years Known/ Relationship

Certification and Release

I hereby certify that all statements made in this application are true are correct to the best of my knowledge and belief. I understand and agree that any misrepresentation or omission of facts in my application may be justification for refusal to hire, or termination of employment.

I further understand that an investigative report may be made as to my character and general reputation. I authorize all past employers, schools, persons and organizations having relevant information or knowledge to provide it to Hermitage Country Club, Inc. or its duly authorized representative for its use in deciding whether or not to offer me employment and specifically waive any required written notification. I hereby release employers, schools, persons and organizations from all liability in responding to inquires in connection with my application.

I understand that nothing in this employment application or in the granting of an interview is intended to create an employment contract between Hermitage Country Club, Inc. and me for either employment or for the providing of the benefit. If an employment relationship is established, I understand that my employment can be terminated, with or without cause, at the option of either Hermitage Country Club, Inc. or myself.

In signing this form, I certify that I understand all the questions and statements in this application.

Signature of Applicant:

Date:

If you are having trouble submitting this application, please contact Crystal Frankart at 804.708.8928.

* Bold Fields are Required