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Employment Application
Application for Employment
"
*
" indicates required fields
Date of Application
*
MM slash DD slash YYYY
Position Applying for:
*
Have you ever been employed by HealthTrack Sports Wellness before?
*
Yes
No
Are you a current member of HealthTrack Sports Wellness?
*
Yes
No
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Telephone
Cell Phone
*
Email
*
Date of Birth (if under 18 years of Age)
MM slash DD slash YYYY
Referred by:
How did you hear about our job opening?
*
Availability & Skills
I am applying for:
*
Full Time
Part Time
HealthTrack Sports Wellness offers a vast variety of positions, each requiring its own unique work schedules. Please indicate which days of the week and times you anticipate being available.
SUNDAY
Morning
Afternoon
Evening
MONDAY
Morning
Afternoon
Evening
TUESDAY
Morning
Afternoon
Evening
WEDNESDAY
Morning
Afternoon
Evening
THURSDAY
Morning
Afternoon
Evening
FRIDAY
Morning
Afternoon
Evening
SATURDAY
Morning
Afternoon
Evening
Hidden
Work Availability - Select all that apply:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Hidden
Work Availability - Select all that apply:
Morning
Afternoon
Evening
Seasonal Availability:
Winter
Spring
Summer
Fall
Date Available to Begin Work:
*
MM slash DD slash YYYY
Requested Wage/Salary:
Skills, Qualifications & Training
Word/Google Docs
Publisher
Excel/Google Sheets
CSI
CPR
Personal Trainer Certification
Group Fitness Certification
Life Guard
Fitness Certification
Other Training, Skills & Volunteer Work
Employment History
Starting with your most recent employer, provide the following information.
Employer:
Telephone #:
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Your Title:
Your Rate of Pay:
Describe your primary responsibilities:
Supervisor's Name:
Direct Telephone #:
Can we contact this individual for employment reference?
Yes
No
Dates of Employment:
Reason for Leaving:
Employer:
Telephone #:
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Your Title:
Your Rate of Pay:
Describe your primary responsibilities:
Supervisor's Name:
Direct Telephone #:
Can we contact this individual for employment reference?
Yes
No
Dates of Employment:
Reason for Leaving:
Employer:
Telephone #:
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Your Title:
Your Rate of Pay:
Describe your primary responsibilities:
Supervisor's Name:
Direct Telephone #:
Can we contact this individual for employment reference?
Yes
No
Dates of Employment:
Reason for Leaving:
Education
College:
Years Attended:
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Degree Attained:
College:
Years Attended:
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Degree Attained:
High School:
Years Attended:
Diploma
GED
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
References
Name
First
Last
Employer
Telephone #:
Name
First
Last
Employer
Telephone #:
Name
First
Last
Employer
Telephone #:
Application Statement
I certify that all information I have provided in order to apply for and secure work with the employer is true and complete. I expressly authorize, without reservation, HealthTrack Sports Wellness, the employer, its representatives, employees or agents to contact and obtain information from all references, employers, public agencies, and educational institutes to otherwise verify the accuracy of all information provided by me in this application and release HealthTrack Sports Wellness, the employer, its representatives, employees or agents from all liability for any damages that may result from utilization of such information. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any application from consideration of employment on a basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate at any time, with or without cause and with or without prior notice, except as required by law. This application does not constitute an agreement or contract for employment for any specified period or definitive duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing expressed language. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States of America and that federal immigration laws require me to complete an I-9 Form in this regard. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to eliminate me from further consideration for employment, or may result in my immediate discharge from the employer’s service, whenever it is discovered.
A copy of this application will be sent to the email address you have provided.
Electronic Signature
*
Date
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MM slash DD slash YYYY
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