PIPING ROCK CLUB Employment Application

Piping Rock Club ("Club") is an Equal Opportunity Employer and will not discriminate nor tolerate discrimination against any employee or applicant for employment based on race, creed, color, national origin, religion, age, sex, sexual orientation, marital status, alienage, disability, domestic violence victim status, genetic predisposition, military status, prior conviction record, veteran's or any other characteristic protected by applicable federal, state, or local laws.
The Club will endeavor to make a reasonable accomodation to the known physical or mental limitations of a qualified applicant with a disability, as well as an applicant's religious beliefs and practices, unless the accomodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please let us know.

General Information

Pursuant to the Immigration Reform and Control Act of 1986, all applicants who are offered employment must produce documents establishing their identity and authorization for employment in the United States. These documents must be produced no later than seventy-two (72) hours after employment commences. In addition, all new hires will be required to verifty their employment authorization under oath be signing INC Form 1-9. 
Will you now or in the future require sponsorship for employment visa status? *

Employment Information

Is there anything that would prevent you from working any day or time of the week or regularly working overtime? *
Have you ever been employed by us? *
Have you ever applied for employment with us? *
Do you have any relatives working for us? *
Have you ever been convicted of a criminal offense that has not been expunged, sealed, pardoned, annulled, discharged, statutorily eradicated or dismissed upon condition of probation? *

Personal References

Educational History

Please provide Name & Location for the following

Employment History

Instructions for completing this section: Please print and list all prior employers, beginning with your PRESENT or MOST RECENT employer. Please attach additional sheets to this application if necessary. Complete all requested information in full. DO NOT include overtime, bonus, commissions, etc. in the base salary information. Please include as part of your employment history any verified work performed on a volunteer basis and/or work performed while in the \.
Is there any reason why we should not contact any current or former employer for a reference? *
Applicant's Statement
I have read and fully understand the questions asked in this application. I certify that all of the answers I have given are true, accurate and complete. I understand that the omission and/or misrepresentation of any fact from or on this application or during any interview will result in immediate rejection of my application or if I am hired will be cause for immediate dismissal. Unless I noted otherwise, I authorize the Club to contact all my employment references and personal references, as well as the education institutions I have attended. I further authorize the Club to inquire about, investigate and obtain copies of any records which relate to me from my former employers and educational institutions. I hereby release the Club and all affiliated persons and entities, as well as any person or institution that provides the Club with any lawful information about me, from any and all liability whatsoever resulting from any such lawful inquiry, investigation or communication.
If hired, I agree to abide by all of the rules and regulations of the Club. I understand and agree that nothing in this application shall constitute an offer, a contract or a guarantee of employment for a specific period of time. If hired, I understand that my employment may be terminated with or without cause and with or without notice at any time, at the will of the Club or me. I further understand that no representative or agent of the Club, other than the General Manager, has the authority to enter into any agreement for employment for any specific period of time, or to make an agreement contrary to the foregoing. I also understand that any agreement modifying my at-will employment status must be in writing (in an individual case or generally) and signed by the General Manager. In addition, I understand that the Club and all plan administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms and conditions of employment.
I understand that any hiring decision is contingent upon my successful completion of all the Club's lawful pre-employment checks, which may include a background check. I agree to execute any consent forms necessary for the Club to conduct its lawful pre-employment checks.
Please sign your actual signature below using your mouse, or finger if you are using a touch screen device.
Electronic Signature *
Disclosure to Applicant and Consent to Request Consumer Report Information
      I understand that Piping Rock Club ("Club") will utilize the services of a consumer reporting agency as part of the procedure for processing my application for employment. I also understand if my application for employment is granted, the Club may obtain further information through subsequent investigations by a consumer reporting agency so as to update, renew or extend my employment.
      I understand a consumer reporting agency's investigation may include obtaining information regarding my credit background, references, character, past employment, work habits, education, general reputation, person characteristics, mode of living, judgment, liens and criminal conviction record consistent with federal and state law.
      I understand such infromation may be obtained by direct or indirect contact with former employers, schools, financial institutions, landlords and public agencies or other persons who may have such knowledge.
       I also understand that before the Club takes any adverse action, in whole or part, on information obtained in the report, I will be provided a copy of the report and a description in writing of my rights under the federal Fair Credit Reporting Act.
      I understand if I disagree with the accuracy of any information in the report, I must notify the Club within five business days of my receipt of the report that I am challenging the accuracy of the information with the Consumer Reporting Agency.
      I hereby consent to this investigation and authorize the Club to procure reports on my background as stated above from a consumer reporting agency. 
Please sign your actual signature below using your mouse, or finger if you are using a touch screen device.
Electronic Signature *
Authorization for a Background Check
After reading the Background Check Disclousre and Authorization Form, I authorize the Club to procure a background check report on me that is prepared by a consumer reporting agency. I understand that, if I am hired, the club may rely on this authorization to procure additional background check reports during and throughout my employment without asking for futher authorization.
I further authorize the following entities to disclose to the consumer reporting agency and its agents all information about or concerning me, including, but not limited to: my past and present employers; learning institutions; including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies all other private and public sector repositories of information; and, any other person, organization or agency with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concering my employment history, earnings history, education, credit history, motor vehicle history, criminal history, drug tests results, military service, professional credentials, and all other information requested by the consumer reporting agency or its agents.
I affirm the information I have provided on this form is true and correct. I understand that dishonesty will disqualify me from consideration for employment with the Club, or if I am hired, that I may be fired.
I agree that a facsimile or photocopy of this form my be used in lieu of the original.
Please sign your actual signature below using your mouse, or finger if you are using a touch screen device.
Electronic Signature: *