Application for Employment
(Pre-employment Questionnaire)    (An Equal Opportunity Employer)

PERSONAL INFORMATION                                                                                                    Date: 
Name:      
Address:
City:    State:   Zip:
Day Phone#:
Home Phone#:
E Mail:
Are you 18 years or older?  Yes   No

EMPLOYMENT DESIRED

Full Time     Part Time           Hours Available

Department (Check all that apply)

Fitness Floor Group Ex. Instructor  Aquatics
Locker Room Maintenance Management
Kid's Club Personal Trainer  Spa Services
Sales Service Desk Bistro

Position      Date you can start:

Are you currently employed?
Yes    No      If Yes, who is your employer? 

Have you ever applied to or been employed by a Premier Sports Club before?
Yes    No   
If Yes, which?    Kinsale Golf & Fitness Club     Premier at Sawmill        Scioto Reserve Golf & Athletic Club
                        Sawmill Athletic Club               Westerville Athletic Club
 

EDUCATION

                                                                                             

Name & Location of School

# of Yrs. attended

Field of Study

Graduated

High School 

 

 Yes    No 

College

 

Yes    No  

Trade/Bus/Corres/Military

 

Yes    No  

SPECIAL SKILLS OR CERTIFICATIONS

Type Expiration Date Authorizing Organization
WSI
CPR
First Aid
Group Ex. Cert.
PT Certification

FORMER EMPLOYERS (List below your last three employers, starting with the most recent first.)
Date (month & year) Employer Name & Address Salary   Position  Reason for Leaving
From: To:
From: To:
From: To:
REFERENCES  (Give the names of three people not related to you, whom you have known for at least one year.)
Name Address Business Phone Years Acquainted

Are you related to a current Premier employee?    Yes    No 
PHYSICAL RECORD


Do you have any physical limitations that preclude you from performing any work for which you are being considered?

Yes    No   If yes, what can be done to accommodate the limitation? 

In case of emergency, notify:   Name

Address

Phone

Relationship

CRIMINAL RECORD


Have you at any time been convicted, other than in juvenile court, of a felony or misdemeanor other than minor traffic violations?  A criminal record does not constitute automatic bar to employment but will be considered in terms of the work to be performed.  Failure to discluse a criminal conviction will result in termination.

Yes    No   If yes, please give the date(s), city, offense and disposition.

Date(s) 

City 

Offense 

Disposition 


“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified information on this application shall be grounds for dismissal.  I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.  I give Premier at Sawmill permission to seek a copy of my arrest record from the Franklin County Sheriff’s Office.   I do hereby release the Franklin County Sheriff’s Office and all individuals connected therewith from all liability.  I understand and agree that, if hired, my employment is for no definite period and may, regardless of date of payment of my wages and salary, be terminated without any prior notice.”

   Yes    No  

ACKNOWLEDGE YOU HAVE READ THE ABOVE STATEMENTS BY INCLUDING YOUR INITIALS AND TODAY'S DATE:
Initials:     Date: