Rev 2012 Old Sandwich Golf Club EMPLOYMENT APPLICATION The Old Sandwich Golf Club offers equal employment opportunity to all applicants for employment and all employees regardless of sex, sexual orientation, age, race, color, religion, national ancestry, veteran status, disability, genetic information or any other status protected by applicable law. An applicant who does not meet the minimum qualifications of the position(s) for which the applicant applies will not be considered for employment. *Please print clearly and sign where indicated PERSONAL DATA: Name: _______________________ Last name _____________________ ____ _______________ First name Initial Familiar/Nickname Telephone: Home ____________________________Mobile ______________________________ Present Address: ______________________________________________ __________________________ ________ _____________ Street Number/Name City State Zip Code Email Address: _____________________________________________ If you are under 18 years of age, could you furnish a work permit? _____ yes _____ no Are you legally authorized to work in the United States? _____ yes _____ no If you are hired, will you be able to submit proof of the above? _____ yes _____ no Position(s) applied for: ______________________________________________________________________________ If position requires travel, do you have a valid driver’s license? Dates Available: _____ yes _____ no Start ___________________________________ End ____________________________________ Hours Available: ___________________________________________________________________________________ EMPLOYMENT HISTORY: Have you ever applied for employment with the Old Sandwich Golf Club? _____ yes _____ no If yes, when? ___________ How did you hear about us? ____________________________________________________ Are you presently employed? _____ yes _____ no Have you ever been discharged from a position? _____ yes _____ no If yes, please provide details (when and reason for discharge): __________________________________________________________________________________________________ Employment history continued on back ... List all of your places of employment beginning with the most recent. You may include work performed on a volunteer basis. Please account for any time period between positions when you were not working. The Old Sandwich Golf Club may contact any of these persons or entities for an employment reference. Name and Address of Employer: Telephone: _______________________________________________________________________________________________ From _____ /_____ To_____ /_____ Manager/Supervisor ______________________Telephone ________________ Describe your Job Duties/Responsibilities: _______________________________________________________________________________________________ Starting Salary: $ ________ Per ________ Ending Salary: $ ________ Per ________ Name and Address of Employer: Telephone: _______________________________________________________________________________________________ From _____ /_____ To_____ /_____ Manager/Supervisor ______________________Telephone ________________ Describe your Job Duties/Responsibilities: _______________________________________________________________________________________________ Starting Salary: $ ________ Per ________ Ending Salary: $ ________ Per ________ Name and Address of Employer: Telephone: _______________________________________________________________________________________________ From _____ /_____ To_____ /_____ Manager/Supervisor ______________________Telephone ________________ Describe your Job Duties/Responsibilities: _______________________________________________________________________________________________ Starting Salary: $ ________ Per ________ Ending Salary: $ ________ Per ________ Name and Address of Employer: Telephone: _______________________________________________________________________________________________ From _____ /_____ To_____ /_____ Manager/Supervisor ______________________Telephone ________________ Describe your Job Duties/Responsibilities: _______________________________________________________________________________________________ E XPERIENCE: (Please circle any prior experience) E XPERIENCE: (Please circle any prior experience) Starting Salary: $ ________ Per ________ Ending Salary: $ ________ Per ________ EXPERIENCE (please circle any prior experience): Management Front Desk Sales/Promotions Maid Services Maintenance Management Front Desk Sales / Promotions Maid Services Maintenance Line Cook Server Banquets Busser Bartender Dishwasher Groundskeeper Golf Valet Additional Experience: _____________________________________________________________________________ __________________________________________________________________________________________________ Qualifications /Special Training (i.e.T.I.P.S, ServSafe) ________________________________________________________ __________________________________________________________________________________________________________ EDUCATION AND TRAINING: NAME OF SCHOOL & ADDRESS YEARS ATTENDED COURSE OF STUDY/MAJOR DIPLOMA /DEGREE Please list any awards or honors: ______________________________________________________________ PERSONAL AND PROFESSIONAL REFERENCES (please do not list relatives): NAME, OCCUPATION AND RELATIONSHIP TO YOU ADDRESS TELEPHONE NUMBER STATEMENT OF UNDERSTANDING: CERTIFICATION (PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY): I hereby certify and affirm that the information provided in conjunction with the application process, including the information provided on this Employment Application and any resume submitted is true, accurate, and complete and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I hereby authorize the Old Sandwich Golf Club to investigate all information pertinent to my Application for Employment in order to determine my qualifications for employment which will include contacting former and/or current employers or any other person or entity listed on this application. I hereby authorize all persons and entities having information relevant to my application to provide that information to the Old Sandwich Golf Club and release them from any liability arising out of or as a result of the request for, provision of, or use of such information. I understand that any offer of employment may be rescinded or my employment terminated if my references are inadequate or unacceptable to the Old Sandwich Golf Club or if I violate any of the provisions of this Certification. I further understand that if I am hired by the Old Sandwich Golf Club, I must abide by all the rules and policies of the Old Sandwich Golf Club which, other than the “at will” employment policy, may be changed without notice at the discretion of the Old Sandwich Golf Club. I understand that completion of this Application for Employment does not assure me of a position with the Old Sandwich Golf Club. I also understand that neither this application nor any other document constitutes a contract for employment for a specific term and that any employment relationship that may be established will be “at will”. As such, any employment relationship I may have with the Old Sandwich Golf Club may be terminated at any time, for any reason or no reason, by me or the Old Sandwich Golf Club. I understand that any omission, misrepresentation, or falsification in conjunction with this application process may be grounds for denial of employment, or, if hired, immediate termination of employment. Massachusetts General Laws c.149 s19B requires that the following statement be included on employment applications: “It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal and civil liability.” Massachusetts General Laws c.151B defines “genetic information” as any written record or explanation of a genetic test of a person’s family history with regard to the presence, absence, or variation of a gene. A genetic test is broadly defined as “any test of DNA, RNA, mitochondrial DNA, chromosome or proteins for the purpose of identifying genes or genetic abnormalities.” The law expressly excludes drug and alcohol test from this definition, meaning that employers may continue to conduct such tests in accordance with existing legal requirements. These new statutory provisions specifically prohibit employers from (1) terminating or refusing to hire individuals on the basis of genetic information; (2) requesting genetic information concerning employees, applicants or their family members; (3) attempting to induce individuals to undergo genetic tests or otherwise disclose genetic information; (4) using genetic information in anyway that affects the terms and conditions of an individual’s employment; or (5) seeking, receiving or maintaining genetic information for any non –medical purpose. Today’s Date ____/____/____ Applicant’s Signature: ___________________________________________ Old Sandwich Golf Club JOB REFERENCE WAIVER Applicant’s Name (print) _____________________ ________________ First Middle _______________________ Last I hereby authorize the Old Sandwich Golf Club to investigate all information pertinent to my Application for Employment in order to determine my qualifications for employment which will include contacting former and/or current employers or any other person or entity listed on this application. I hereby authorize all persons and entities having information relevant to my application to provide that information to the Old Sandwich Golf Club and release them from any liability arising out of or as a result of the request for, provision of, or use of such information. I understand that any offer of employment may be rescinded or my employment terminated if my references are inadequate or unacceptable to the Old Sandwich Golf Club or if I violate any of the provisions of this Certification. Applicant’s Signature (sign) ______________________________________ Date ______ / ______ / ______ The above named individual has applied for a position with our company. She/he authorizes Old Sandwich Golf Club to secure relevant information about their employability with our organization. Please provide the following information and feedback: Dates of Employment: ___________________ to __________________ Position Held: _________________ Is s/he eligible for Re-Hire? Yes ______ No ______ Final rate of pay? _____________ per hour/week/annual Please rate the candidate in the following areas: (mark with an “X”) Job Performance: Excellent ___ Good ___ Fair ___ Poor ____ Work Ethic/Productivity: Excellent ___ Good ___ Fair ___ Poor ____ Attendance/Reliability: Excellent ___ Good ___ Fair ___ Poor ____ Attitude/Willingness: Excellent ___ Good ___ Fair ___ Poor ____ Team Player: Excellent ___ Good ___ Fair ___ Poor ____ Responsibilities:_________________________________________________________________________ What have I not asked that might be useful to know about this individual?___________________________ ______________________________________________________________________________________ Additional comments: _______________________________________________________________________ __________________________________________________________________________________________ Reference Name and Title:_________________________________________ Date ______/______ / _____ Old Sandwich Golf Club ~ 41 Doublebrook ~ Plymouth, MA 02360 ~ Phone 1-508-209-2200 ~ Fax 1-508-209-2299
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