Work Lake Winnie Form – Fill Out and Use This PDF

Lake Winnepesaukah Amusements, Inc.

Employment Application

Lake Winnepesaukah Amusements, Inc. is an equal opportunity employer that recruits for all jobs

without regard to race, color, sex, age, religion, handicap, national origin or any other basis protected by law.

Please Respond to ALL Questions

	For Office Use Only:
Hire Date: ___________	Department: __________	Pay Rate: ___________
Personal Information:
Name (Last, First, Middle): _________________________________________		Nickname: _______________________

Address: __________________________________________________________________________________________________

Street	City	State		Zip Code
Home Phone Number: (______) _____________________	Social Security # ________ ________			________
Cell Phone Number: (_____) _______________________	Email Address: ___________________________________
Are you legally eligible for employment in the United States? Yes ฀		No ฀
Are you 18 years of age? Yes ฀ No ฀ If not, what is your date of birth?			Age _______

Have you ever been convicted of any crime in the past ten years, excluding misdemeanors and summary judgments, which

have not been annulled, expunged or sealed by a court? Yes ฀ No ฀ If you answered yes, explain: ______________________

__________________________________________________________________________________________________________

Do you attend school? Yes ฀ No ฀ School Name:			Last Grade Completed _______
Emergency Contact Person: _______________________________		(______) __________________ ______________________
Name		Phone Number	Relationship
Work Information:
Have you ever worked for Lake Winnepesaukah? Yes ฀ No ฀		What Year? ___________ Department: ________________

Supervisor: ________________________ Reason for leaving: ______________________________________

The position you desire? _______________ Hours you can work? __________________ Date available? ___________________

Friends and/or Relatives working for Lake Winnepesaukah: ________________________________________________________

		Name				Relationship
Employment Information:
Are you currently employed? Yes ฀ No ฀
Current/Previous Employer: ______________________________________ Employed From:							To: ____________
Supervisor: ______________________________ Phone Number: (		)				Pay Rate: ___________________

Job Title: ________________________________ Reason for leaving: _________________________________________________

Previous Employer: _________________________________________ Employed From:							To: ________________
Supervisor: ______________________________ Phone Number: (		)				Pay Rate: ___________________

Job Title: ________________________________ Reason for leaving: _________________________________________________

Previous Employer: _________________________________________ Employed From:							To: ________________
Supervisor: ______________________________ Phone Number: (		)				Pay Rate: ___________________

Job Title: ________________________________ Reason for leaving: _________________________________________________

Previous Employer: _________________________________________ Employed From:							To: ________________
Supervisor: ______________________________ Phone Number: (		)				Pay Rate: ___________________

Job Title: ________________________________ Reason for leaving: _________________________________________________

The information I have provided on this application is true and complete to the best of my knowledge. I authorize investigation of all statements and facts on this application, and I waive all rights and claims I may otherwise have against the employer for seeking and using this information to evaluate my request for employment. I understand that false, incomplete or misrepresentations in information of any kind will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment. I understand that a pre-employment survey and a drug screen might be required as a condition of employment. If I am employed, I understand I am employed “at will” and that my employment, including a 90 day trial probationary period, can be terminated at anytime with or without cause and with or without notice.

Applicant’s Signature: _________________________________________________________

Date: ___________________