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| Street Address: | Apartment/Unit #: |
| City | State | Zip |
| Home Phone No. | Cell Phone No. | Email
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How did you hear about us? (Select all that apply) | Online | Newspaper Ad |
| Current Employee | Employment Agency |
| | Other | |
| | | |
If by Current Employee, please list:
| If Other, please list:
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Are you a citizen of the United States?
Yes No | If no, are you authorized to work in the U.S.?
Yes No
(Proof of eligibility will be required upon offer of employment) | Have you ever been convicted of a felony?
Yes No
(A conviction will not necessarily disqualify you.)
If yes, explain:
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Are you 18 years of age or older?
Yes No
(If no, you maybe required to provide authorization.) | Can you with or without reasonable accommodation perform the essential functions of the job for which you are applying?
Yes No
(If you have any questions about the functions of the job, please ask the interviewer before answering this question.) | Have you ever worked for CCNC before?
Yes No
If so, when?
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Are you related by blood or marriage to a current employee of CCNC?
Yes No
If YES, please give name and relation to you
| Are you related to a current CCNC Member?
Yes NO
If YES, please give name and relation to you
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| EMPLOYMENT |
Type of Employment Desired
| Position(s) Applied for
| What is your means of transportation to work?
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What hours and shift(s) would you prefer to work?
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Date Available to start work?
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Are you willing to work overtime?
Yes No
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| Select days available to work: | Monday | Tuesday |
| | Wednesday | Thursday |
| | Friday | Saturday |
| | Sunday | |
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| EDUCATION |
| High School |
Address
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| From | To | Did you graduate?
Yes No
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| Degree: |
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| College |
| Address |
| From | To | Did you graduate?
Yes No |
| Degree: |
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| Other |
| Address |
| From | To |
Did you graduate?
Yes No
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| Degree |
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REFERENCES
Please list three professional references. |
Reference 1
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| Full Name | Number | Years Known
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Reference 2
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| Full Name | Number | Years Known
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Reference 3
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| Full Name | Number | Years Known
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| EMPLOYMENT HISTORY |
Begin with current or most recent employer. Do not exclude any employment. Include any applicable temporary employment-attach another sheet if necessary. Previous salary or wages will not be used to determine compensation at CCNC. |
Employment 1
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| Company | Phone No. | |
| Street Address |
| City | State
| Zip
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| Supervisor's Name and Title | | |
Dates Employed:
From |
To | |
Rate of Pay:
From
|
To
| |
Describe the Work Performed:
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May we contact your previous supervisor for a reference?
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Employment 2
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| Company | Phone No. | |
| Street Address |
| City | State
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| Supervisor's Name and Title | | |
Dates Employed:
From |
To | |
Rate of Pay:
From
|
To
| |
Describe the Work Performed:
|
May we contact your previous supervisor for a reference?
|
Employment 3
|
| Company | Phone No. | |
| Street Address |
| City | State
|
| Supervisor's Name and Title | | |
Dates Employed:
From |
To | |
Rate of Pay:
From
|
To
| |
Describe the Work Performed
|
May we contact your previous supervisor for a reference?
|
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PLEASE READ CAREFULLY BEFORE SIGNING
The Country Club of North Carolina is an equal opportunity employer. CCNC 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 CCNC to hire me. If I am hired, I understand that either CCNC 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 CCNC has the authority to make any assurance to the contrary. I attest with my signature below that I have given CCNC true and complete information on this application. No requested information has been concealed. I authorize CCNC 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 CCNC employee I will be required to complete a screening test for illegal drugs, illegally used legal drugs and/or alcohol 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 CCNC employee I will be required to undergo a criminal background investigation. |
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| Yes, I acknowledge that I have read, understood and agree to the above statements. |
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| By signing and or completing by printing my name below, I acknowledge that I have read, understood and agree to the above application. |
| Signature (provide initials) | Date
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