Pump It Up Job Form – Fill Out and Use This PDF

Pump It Up Job Application

1.

Position Applied For:

(

circle one

)

Staff member or

Manager

2.

Social Security No.:

3.

Full legal Name:

Last Name

First

Middle

4.

Home Phone:

(

)

-

Cell Phone

(

)

-

5.

Street Address:

6. E-mail Address:

City

State

Zip

7.

Education:

7a.

Highest school grade completed:

10

11

12 GPA

_________

7b.

Do you have a high school equivalency diploma:

Yes

No

7c.

Number of years of post high school education:

2

3

4

1

8. Name and Location of Educational Institution:

Degree Received

Major / Specialty

Dates Attended

8a.

8b.

8c.

9.If you plan to complete an educational program in the future, then indicate the degree or program to be completed

9a. Completion Date:

10.Work Experience: Start with the most recent work experience. Describe all traditional, military and voluntary work experience. Describe your knowledge, skills and abilities that demonstrate your qualifications for the position for which you are applying.

10a. Job Title

Employer Name

Employer Address

Job Duties:

Phone

_________________________________________

Supervisor / Manager

Title

Final Salary

Dates (Month/ Year)

To

Reason for leaving

Hours/week

_________________________________________

10b. Job Title

Employer Name

Employer Address

Job Duties:

Phone

_________________________________________

Supervisor / Manager

Title

Final Salary

Dates (Month/ Year)

To

Reason for leaving

Hours / Week

_________________________________________

11.Job Skills: Use the following space to provide any additional information that you think would be helpful in our evaluation of your job application. This can

include specialized training, seminars, workshops, accreditations, special achievements or valuable skills:

_____________________________________________________________________________________________________

12.Licenses Held: (including drivers) or certifications to practice a trade or profession.

	Type			License Number		Granted by (licensing board)

13.References:

List the full name, address, phone number and relationships of up to three persons that you’d like to use as a reference:
Full Name	Address	Phone Number	Relationship

14.Miscellaneous Information:

14a.

Which shifts are you willing to accept:

Day

Evening

Night

Rotating

Weekends Specify shift hours

14b.

Which job status are you willing to accept:

Full-time

Part-time (specify)

14c. If you are under 18 years of age, please list your Mother and Father’s Names and cell numbers:

Mother

:______________________________(

)______ -_______

Father:

______________________________( )_____ -__________

15. Compliance with the Immigration Reform and Control Act requires that you

Yes

No.

are you legally eligible for employment in the United States?

Please note that under the Immigration Reform and Control Act of 1986, that you may be required to fill out a certification verifying that you are eligible to be employed and verifying your identity. You may also be will be required to provide documentation that you should you be employed.

16. Veteran Status: Are you a veteran who received an honorable discharge and has:

1.Provided more than 180 consecutive days of full time active duty in the armed forces of the United States or reserve components, including more than the National Guard?, or

2.Have a military service disability rating fixed by the United States Veterans Affairs?

Yes No. If yes, did you serve during the Vietnam Conflict (2/28/61-3/7/75)? Yes No

17. Prior Convictions:

17a. Have you ever been convicted of any violation of law, including moving traffic violations:

Yes

No

If yes, then please provide the following:

Describe the Offense :

Statute / Ordinance (if known):

Date of Charge:

; Date of Conviction

County, City, and State of Conviction:

17b. Have you ever been ordered by a court to not work around children? (if Yes, please explain) :

Yes

No _______________________________

_________________________________________________________________________________________________________________

18. Work Start Date: When will you be available to start work? If you are available as soon as you given two weeks notice, then no dates are necessary.

Month

Day

Year

19.Job Application Certification:

I hereby certify that all entries on this job application and any attachments are true and complete. I also agree and understand that any falsification this information may result in my forfeiture of employment. I understand this application is not a guarantee for an interview or position at this company.

I hereby understand that a background check may/will be run before/during employment with Pump It Up.

I understand that all information on this job application is subject to verification and I consent to criminal history and background checks. I also agree that you may contact references and educational institutions listed on this application

Dated				Job Applicant Signature

Any Additional Information you would like us to know about you, please include on this page: