Burnt Mountain Center -
Employment Opportunities
 
 
APPLICATION FOR EMPLOYMENT

This application is not an employment contract, but merely is intended to provide information necessary to evaluate suitable for employment. It is the policy of BMC to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, martial status, national origin, citizenship, disability, genetic information, veteran status, or any other status protected under state or federal law. It is also the policy of BMC to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a medical examination, which may include a drug test or other physical evaluations. This application will remain active for 180 days.

PERSONAL INFORMATION

Name (Last, First, Middle)
Social Security Number
Referred by
Home Phone
Work Phone

CURRENT ADDRESS

Address Line 1
Address Line 2
City
State
Zip Code

PREVIOUS ADDRESS 1

Address Line 1
Address Line 2
City
State
Zip Code

PREVIOUS ADDRESS 2

Address Line 1
Address Line 2
City
State
Zip Code

EDUCATION

High School Attended
City
County
State
Did you earn a diploma?
Yes
No

Undergraduate Attended
City
State
Areas of Study
Degree/Certification/Diploma

Graduate School Attended
City
State
Areas of Study
Degree/Certification/Diploma

Trade, Business, Other School Attended
City
State
Areas of Study
Degree/Certification/Diploma

EMPLOYMENT INFORMATION

Position Applied For
Date You Can Begin Work
Desired Salary
What hour you are available to work?
Can you work
Nights
Weekends
Are you at least 18 years of age and legally eligible for work in the United States?
Yes
No
Will you work overtime when necessary?
Yes
No
Have you ever been discharged or asked to resign from a job?
Yes
No
If yes, please explain
Have you ever been convicted of or pled guilty to a felony or other crime? (This question does not pertain to convictions that have been expunged under Georgia law)
Yes
No
If yes, please explain

REFERENCES
Please list the names of three persons not related to you, whom you have known at least one year.

Name
Phone Number
Business
Years Acquainted

Name
Phone Number
Business
Years Acquainted

Name
Phone Number
Business
Years Acquainted

EMPLOYMENT HISTORY

May we contact your present employer?
Yes
No
Most Recent Employer
City
State
Zip Code
Phone Number
Position Held
Start Date
End Date
Pay Rate Upon Leaving
Supervisor
Duties
Reason for Leaving

Next Most Recent Employer
City
State
Zip Code
Phone Number
Position Held
Start Date
End Date
Pay Rate Upon Leaving
Supervisor
Duties
Reason for Leaving

Next Most Recent Employer
City
State
Zip Code
Phone Number
Position Held
Start Date
End Date
Pay Rate Upon Leaving
Supervisor
Duties
Reason for Leaving

JOB-RELATED SKILLS

Do you have a valid driver's license?
Yes
No
Drivers License Number
Expiration Date
Date of Issue
Have you ever been convicted of or pled guilty to any traffic-related offense within the past five years?
Yes
No
Have you ever had your driver's license suspended or revoked?
Yes
No
Have you had your driving privileges modified by a court of law?
Yes
No
Please list all states from which you hold or have held a driver's license
Please use this space to list any special skills you may have that relate to the position applied for
Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for (please include date granted, name of organization, any other relevant information)

APPLICANT'S CERTIFICATION AGREEMENT

1) I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how it was discovered.

2) I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation.

3) If I am offered and accept a position, I agree to conform to all existing and future company rules and regulations and I understand that the company reserves the right to change wages, hours, and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.

4) I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof or identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.

I have read and review the information provided in this application and the above statements. By agreeing, I certify that I understand all parts of this application and have answered all questions completely and fully.
I agree
I disagree
Date Completed
 
 
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