Application for Employment at the Campus Club

Pre-Employment Questionnaire -- An Equal Opportunity Employer
4th Floor Coffman Memorial Union | University of Minnesota | CampusClubUMN.org | 612-626-7788

PERSONAL INFORMATION

Last Name *

First Name *

Middle Name:

Present Address (Street, City, State, Zip): *

Permanent Address (Street, City, State, Zip): *

Phone Number: *

Email Address: *

Are you 18 years or older? *

Yes

Are you prevented from lawfully becoming employed in this country due to visa or immigration status? *

Yes

EMPLOYMENT DESIRED

Position: *

Desired Pay:

Are you currently employed?

If so, may we contact employer?

Have you applied here previously? *

If so, when?

Date you can start: *

Referred By:

EDUCATION

High School | Name and Location: *

Did you graduate? *

Yes

College | Name and Location:

Did you graduate?

Yes

Trade/Technical | Name and Location:

Did you graduate?

Yes

Additional | Name and Location:

Did you graduate?

Yes

SKILLS/TRAINING

Special Skills: *

Certifications/Classes/Trainings you have completed:

EMPLOYMENT HISTORY

Month/Year Employed: *

Name and Location of Business (City/State): *

Position: *

Reason for leaving: *

Pay Rate: *

Month/Year Employed:

Name and Location of Business (City/State):

Position:

Reason for leaving:

Pay Rate:

Month/Year Employed:

Name and Location of Business (City/State):

Position:

Reason for leaving:

Pay Rate:

Which of these jobs did you like best and why? *

REFERENCES

Name: *

Place of Employment: *

Title: *

Years Acquainted: *

Name:

Place of Employment:

Title:

Years Acquainted:

Name:

Place of Employment:

Title:

Years Acquainted:

We assume that contact information for the listed references will be available upon request.

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, with or without notice, at any time at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president, and then only when in wrong and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

Date: *

Digital Signature: *

By digitally signing this form, you certify that all the information submitted on this application is true and complete to the best of your knowledge.

Submit

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