Employment Application - Country Club of Scranton

I understand that in no event shall my hiring be considered as creating a contractual relationship between myself and The Country Club of Scranton and unless otherwise provided in writing, such relationship shall be defined as “employment at will” where either party may dissolve the relationship. I hereby direct and authorize the Commonwealth of Pennsylvania Attorney General Office of Bureau of Criminal Investigation to make available to The Country Club of Scranton any criminal record that the Bureau of Criminal Investigation has on file in reference to me. I hereby waive and release any and all manner of actions, cause of actions, and demands of every kind, nature, and description, arising from any release of criminal records and requests there from, whatsoever against the Commonwealth of Pennsylvania Attorney General Office of Bureau of Criminal Investigation in both law and equity, which I may now have or in the future may have. I agree to submit to legally permissible drug and/or alcohol testing upon request by The Country Club of Scranton. I recognize that the result of these tests may be used to determine my employment or continued employment. I understand and expressly agree that if employed by The Country Club of Scranton storage areas provided to me (Locker, Desk, Etc.) are open to investigation by The Country Club of Scranton without prior notice to me. I understand that consideration for employment is contingent on the results of a reference and background check. Therefore, I hereby authorize The Country Club of Scranton to investigate the truthfulness of all statements made in this application, contact my former employers or other persons, who can verify information concerning this application, and release my indemnify each person and organization from liability for providing information to The Country Club of Scranton.

First Name:
Last Name:
Address:
City:
State:
U.S. ZIP code:
Home Phone:	()-First three digitsSecond three digitsLast four digits
Cell Phone:	()-First three digitsSecond three digitsLast four digits
E-mail:
Position(s) Applying for?:*
How were you referred to The Country Club of Scranton? :
If hired, would you have transportation to/from work? :	Yes No
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? :	Yes No
If hired, are you willing to submit to and pass a controlled substance test?:	Yes No
Are you able to perform the essential functions of the job for which you are applying?:	Yes No (Note: The Country Club of Scranton complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)
Have you ever been convicted of a criminal offense (felony or misdemeanor)? :	Yes No
If answered yes, please explain the nature of the crimes(s), when and where convicted and disposition of the case.:	(Note: No applicant will be denied employment solely on the grounds of the conviction of a criminal offense. The date of the offense, nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.) PLEASE BE AWARE THAT THIS IS A CLUB DOCUMENT AND ANY FALSE INFORMTION REPORTED ON THIS DOCUMENT IS GROUNDS FOR IMMEDIATE TERMINATION.
Education / Training - Name & Location of School:
Course of Study:	(List Major)
Graduated?:	Yes No
Type of Degree / Certificate:
Education / Training - Name & Location of School (2):
Course of Study:	(List Major)
Graduated?:	Yes No
Type of Degree / Certificate:
Current / Last Employer's Name, Address, & Phone Number:
Supervisor's Name:
Job Title / Duties:
Employed Dates:
Salary:
Reason for Leaving:
Prior Employer's Name, Address, & Phone Number:
Supervisor's Name:
Job Title / Duties:
Employment Dates:
Salary:
Reason for Leaving:
Provide 3 References (Include Name & Phone Number):
	CONDITIONS OF EMPLOYMENT - Please read below and e-sign your name. I understand that in no event shall my hiring be considered as creating a contractual relationship between myself and The Country Club of Scranton and unless otherwise provided in writing, such relationship shall be defined as “employment at will” where either party may dissolve the relationship. I hereby direct and authorize the Commonwealth of Pennsylvania Attorney General Office of Bureau of Criminal Investigation to make available to The Country Club of Scranton any criminal record that the Bureau of Criminal Investigation has on file in reference to me. I hereby waive and release any and all manner of actions, cause of actions, and demands of every kind, nature, and description, arising from any release of criminal records and requests there from, whatsoever against the Commonwealth of Pennsylvania Attorney General Office of Bureau of Criminal Investigation in both law and equity, which I may now have or in the future may have. I agree to submit to legally permissible drug and/or alcohol testing upon request by The Country Club of Scranton. I recognize that the result of these tests may be used to determine my employment or continued employment. I understand and expressly agree that if employed by The Country Club of Scranton storage areas provided to me (Locker, Desk, Etc.) are open to investigation by The Country Club of Scranton without prior notice to me. I understand that consideration for employment is contingent on the results of a reference and background check. Therefore, I hereby authorize The Country Club of Scranton to investigate the truthfulness of all statements made in this application, contact my former employers or other persons, who can verify information concerning this application, and release my indemnify each person and organization from liability for providing information to The Country Club of Scranton.
Signature of Applicant:
Date: