BLUE MOUNTAIN EMPLOYMENT APPLICATION

BLUE MOUNTAIN EMPLOYMENT APPLICATION
PERSONAL INFORMATION
Today's Date
MM/DD/YYYY
Full Name

First NameMiddle NameLast Name
Your current age (if under 18)
E-mail address
Present address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone number (home)

Area CodePhone Number
Last 4 digits of Social Security number
GENERAL INFORMATION
What position(s) interest you?
*If other, what?
When could you start working?
MM/DD/YYYY
Salary Requested
How did you find out about the position?
*If you selected "other" above
Why are you interested in this position?
Which category do you prefer?
What is your availability?
Have you ever been convicted, pleaded guilty, or pleaded "no contest" to any crime, other than traffic violations?
If yes, please explain
Do you give us authorization to contact unemployment agencies about your work history?
Have you ever been terminated from a position?
If yes, please explain
Have you ever been involved in any litigation, legal claims, or threatened legal claims pertaining to the performance of your job duties?
If yes, please explain
EDUCATION
Highschool name
Location
city/state
Years completed
College/University name
Location
city/state
Major
Years completed
Degree
Post Grad school name
Location
Years completed
Degree
U.S. Military/Trade School/other
Training received
EMPLOYMENT HISTORY/PROFESSIONAL REFERENCES
List your three most recent places of employment, including temporary, regular, and part-time, in date order with most recent first. List military services as part of employment record. This application must be completed in full, even when accompanied by a resumé.

1.
Name of Company
Are you currently working for this employer?
May we contact them?
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Position(s) held
Date of employment: start
MM/DD/YYYY
Date of employment: end
MM/DD/YYYY
Name/Title of immediate supervisor
Starting and ending wages/salary
Reason for leaving
2.
Name of Company
Are you currently working for this employer?
May we contact them?
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Position(s) held
Date of employment: start
MM/DD/YYYY
Date of employment: end
MM/DD/YYYY
Name/Title of immediate supervisor
Starting and ending wages/salary
Reason for leaving
3.
Name of Company
Are you currently working for this employer?
May we contact them?
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Position(s) held
Date of employment: start
MM/DD/YYYY
Date of employment: end
MM/DD/YYYY
Name/Title of immediate supervisor
Starting and ending wages/salary
Reason for leaving
ADDITIONAL EXPERIENCE
Have you held any professional, trade, business, or civic activities and offices?
Please list here:
Describe any other experiences and skills you feel will be beneficial to us as an employer and to the Blue Mountain Team.
Please list here:
PERSONAL REFERENCES
Please list the name, address, and title/position/relationship for two references (not immediate family members)
Name

First NameLast Name
Location
city/state
Title/Company/ Organization
Phone Number

Area CodePhone Number
Relationship to you
Name

First NameLast Name
Location
city/state
Title/Company/ Organization
Phone Number

Area CodePhone Number
Relationship to you
I authorize investigation of all statements contained in this application form if I am considered for employment. I also understand that misrepresentation or omission of facts will be sufficient cause for dismissal from the Company's service. I authorize the checking of any references on matter of record listed on my application and release those providing the information from any liability whatsoever for issuing such information.
Digital (typed) signature here
Date
MM/DD/YYYY
Can you legally work in the US?
By checking "I agree", you understand and confirm that your digital (typed) signature is legally binding.
Do you agree?
Should be Empty:

BLUE MOUNTAIN EMPLOYMENT APPLICATION

PERSONAL INFORMATION

GENERAL INFORMATION

EDUCATION

EMPLOYMENT HISTORY/PROFESSIONAL REFERENCES

ADDITIONAL EXPERIENCE

PERSONAL REFERENCES