APPLICATION FOR EMPLOYMENT

DIAMOND GYMNASTICS & DANCE ACADEMY

PERSONAL INFORMATION DATE________________________

NAME

PERMANENT ADDRESS___________________________________________________________________

HM PHONE#______________________ ALT PHONE#_______________________

SS#__________________________ Are you a U.S. Citizen or alien authorized to work in the U.S.? yes no

EMPLOYMENT DESIRED

POSITION(S)________________ START DATE_____________ SALARY DESIRED_________________

STATUS DESIRED: FULL-TIME PART-TIME DAYTIME EVENINGS WEEKENDS

SPECIFY DAYS & HOURS FOR PART-TIME___________________________________________________

ARE YOU WILL TO SIGN A NON-COMPETE CONTRACT? YES NO

EDUCATION NAME & LOCATION OF SCHOOL DATE GRADUATED DEGREE

COLLEGE

TRADE/BUSINESS

SCHOOL

HIGH SCHOOL

FORMER EMPLOYERS (List below last three employers, starting with last one first)

START/END

DATE NAME OF EMPLOYER ADDRESS OF EMPLOYER PHONE#

POSITION SUPERVISOR SALARY REASON FOR LEAVING MAY WE CONTACT EMPLOYER

START/END

DATE NAME OF EMPLOYER ADDRESS OF EMPLOYER PHONE#

POSITION SUPERVISOR SALARY REASON FOR LEAVING MAY WE CONTACT EMPLOYER

__________________________________________________________________________________________

START/END

DATE NAME OF EMPLOYER ADDRESS OF EMPLOYER PHONE#

POSITION SUPERVISOR SALARY REASON FOR LEAVING MAY WE CONTACT EMPLOYER

__________________________________________________________________________________________

REFERENCES: Name three persons not related to you, whom you have known at least one year.

NAME PHONE NUMBER AFFILIATION PHONE #

1.________________________________________________________________________________________

2.________________________________________________________________________________________

3.________________________________________________________________________________________

IN CASE OF

EMERGENCY NOTIFY____________________________________________________________________

NAME ADDRESS PH# ALT#

I verify that the facts stated in this application are true and accurate to the best of my knowledge. I understand that, if employed, falsified statements on this application will be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give Diamond Gymnastics & Dance Academy any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to Diamond Gymnastics & Dance Academy. I understand and agree that, if employed, my employment is for no guaranteed period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause.

SIGNATURE______________________________________________________ DATE____________________________