Application for Employment

Contact Information

First Name

Last Name

Email Address

Phone

Street Address

Town

State

Zip

Employment History

Begin with current or most recent employer. Do not exclude any employment. Include any applicable temporary employment-attach another sheet if necessary.

Most Recent

Name of Employer

Your role

Dates of Employment

From

Supervisor Name and Title

Telephone Number

2nd Most Recent

Name of Employer

Your role

Dates of Employment

From

Supervisor Name and Title

Telephone Number

3rd Most Recent

Name of Employer

Your role

Dates of Employment

From

Supervisor Name and Title

Telephone Number

Educational Background (If Job Related)

School Name and Location

Years Attended

Did you graduate

Yes

Degrees and/or related areas of study

References

Reference 1

Name

Telephone Number

Relation

Reference 2

Name

Telephone Number

Relation

Reference 3

Name

Telephone Number

Relation

Applicant Acknowledgement and Authorization

PLEASE READ CAREFULLY BEFORE SIGNING

The Brooklawn Club is an equal opportunity employer. The Brooklawn Club does not discriminate in employment on account of race, color, religion, national origins, ancestry, citizenship status, age, sex (including sexual harassment), sexual orientation, marital status, mental or physical disabilities, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for The Brooklawn Club to hire me. If I am hired, I understand that either The Brooklawn Club or I can terminate my employment at any time for any reason, with or without cause and without prior notice. I understand that no representative of The Brooklawn Club has the authority to make any assurance to the contrary.

I attest with my signature below that I have given The Brooklawn Club true and complete information on this application. No requested information has been concealed. I authorize The Brooklawn Club to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

I also understand that in the event I become a Brooklawn Club employee, I may be required to complete a screening test for illegal drugs, illegally used legal drugs and/or alcohol which includes the collection of blood, urine and/or breath samples and other necessary medical tests to determine the presence or use of alcohol, drugs or controlled substances in accordance with the Drug-Free Workplace Policy.

I further understand that in the event I become a Brooklawn Club employee I will be required to undergo a sexual offender background investigation and complete annual sexual harassment prevention training as required by the state of CT

By signing and or completing by printing my name below, I acknowledge that I have read, understood and agree to the above statements.

Signature (Please enter your full name)

Date:

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Application for Employment