Application for Employment

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1 Name: Position: Date: Application for Employment 4735 Carmel Road ~ Charlotte ~ North Carolina ~ ~ Phone ~Fax

2 In 1947, the story of Carmel Country Club began when a group of businessmen envisioned a new golf and social club for Charlotte. Since that vision was realized, Carmel Country Club has grown to become the foremost private, member owned family club of the Queen City offering the best in amenities and activities: two 18-hole golf courses, tennis, swimming, fitness and dining. Carmel has earned recognition as a Platinum Club of America, a Five Star Private Club and was named the number 15 private club in America by Club Leaders Forum. Our standards for employment are high. Every employee is important for the success of the overall operation of the Club and must work together as a team to achieve our ultimate goal. That goal is to provide our Club membership with the best service possible, so that each and every time they utilize Carmel Country Club they feel they are a member of a special organization. Carmel Country Club is an equal opportunity employer.

3 Personal Information Last Name First Name Middle Name Address City County State Zip Home Phone Number Cell/Work Phone Number Social Security # Address Employment Information Department/Position: 1 Full-time 1 Part-time 1 Seasonal/Temp 1 Extern Rate of pay desired: Will you work overtime when required? 1 Yes 1 No Date available to start: Available to work holidays? 1 Yes 1 No Availability: (Please check when you are available.) Morning Afternoon Evening Mon Tues Weds Thurs Fri Sat Sun Have you ever been employed by Carmel Country Club? 1 Yes 1 No If Yes, when? Do you know anyone now working for Carmel Country Club? 1 Yes 1 No If Yes, employee name? If hired can you provide proof that you are eligible to work in the United States? 1 Yes 1 No Have you ever been involved in a work situation which involved yelling, fighting, or physical contact? 1 Yes 1 No Have you ever been fired? 1 Yes 1 No Have you ever been convicted of a felony or any other crimes involving dishonesty or acts against a person in the past ten years? Do not answer Yes if your conviction has been annulled, expunged, or sealed. 1 Yes 1 No Note - The existence of a criminal history will not automatically disqualify you from employment. Each instance and explanation will be considered in relation to the position for which you are applying. If yes, please explain: Date of conviction: City: State: Disposition Results: Are you now, or have you ever been known by any other name, or have you changed your name (first or last)? Previous Name:

4 Skills and Experience How many years of experience do you have relative to the position for which you are applying for? Please list any other job related skills: Employment History Please tell us about previous jobs you have held starting with your current or most recent job. You may include voluntary positions if you desire. You may exclude organization names which may indicate race, color, religion, gender, national origin, disability or other protected status. Please include information for up to 3 jobs. Company Name Telephone Address, City & State Employed From/To (Month & Year) Name of Supervisor Starting/Ending Wage Job Title & Type of Work Reason for Leaving It is ok to contact this employer? 1 Yes 1 No Company Name Telephone Address, City & State Employed From/To (Month & Year) Name of Supervisor Starting/Ending Wage Job Title & Type of Work Reason for Leaving It is ok to contact this employer? 1 Yes 1 No Company Name Telephone Address, City & State Employed From/To (Month & Year) Name of Supervisor Starting/Ending Wage Job Title & Type of Work Reason for Leaving It is ok to contact this employer? 1 Yes 1 No

5 Education High School/GED Name/Location Graduated Degree/Course of Study Years Completed College/ University Graduate Other Please list any special accomplishments, training, licenses and/or certificates, or job related functions that might qualify you for the position for which you are applying. References Please provide information for two references. Please do not include members of your family as references. Name: Relationship: Occupation: City & State: Home Phone: Work Phone: Name: Relationship: Occupation: City & State: Home Phone: Work Phone:

6 Please read the following carefully. Your signature below is required to be considered for employment. It also acknowledges you have read, understand and agree to the information. About this application: I certify the information on this application is true and correct. I understand that any false statements, misrepresentations or omissions of fact may result in the rejection of my application or in immediate separation from Carmel Country Club if I become employed. About inquiries and information from current and former employers and/or personal references: I authorize Carmel Country Club to inquire and receive information from all of my current and former employers, personal references, and educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering, and using such information and other persons, corporations or organizations for furnishing such information. About the employer: I understand Carmel Country Club does not unlawfully discriminate in employment and no questions on this application are used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local or federal law. I understand it is this company s policy not to refuse to hire a qualified individual with a disability because of that person s need for a reasonable accommodation as required by ADA. I understand that I may be asked to submit to random drug testing. About proof of meeting minimum age requirements and the right to work in the United States: I agree to provide proof of meeting minimum age requirements of applicable laws and submit proof of my true age if I am hired. I also consent, if hired to provide proof of the right to work in the United States as required by the Immigration Reform and Control Act of About at-will employment: I agree, if employed to conform to the guidelines and policies of Carmel Country Club, whenever adopted or changed by Carmel Country Club, and that those guidelines and policies do not constitute an employment contract. I further agree that if hired, my employment will be for an unspecified term and may be terminated at the will of either Carmel Country Club, or myself, with or without cause, and with or without notice. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer. I represent and warrant that I have read and fully understand the forgoing and seek employment under these conditions. Signature of Applicant: Date:

7 Background Investigation Authorization and Disclosure Form I understand that Carmel Country Club will utilize the services of STERLING TESTING SYSTEMS, INC., 249 West 17th Street, New York, NY 10011, as part of the procedure for processing my application for employment. I also understand that if my application for employment is granted, Carmel Country Club may obtain further information through subsequent investigations by STERLING TESTING SYSTEMS, INC so as to update, renew or extend my employment, to the extent permitted by law. I understand a consumer reporting agency's investigation may include obtaining information regarding bankruptcies covering up to the last ten (10) years, obtaining information regarding civil suits, civil judgments, arrest records, and paid tax liens covering up to the last seven (7) years, obtaining information regarding any other adverse item of information covering up to the last seven (7) years and obtaining information regarding references and educational and employment verifications without any time limitations, subject to any limitations or exceptions applicable under state and federal law. The investigation also may include obtaining information relating to criminal records without any time limitations, subject to state law. In the event an investigative consumer report is conducted, I understand such information may be obtained by personal interviews with my acquaintances or associates or with others whom I am acquainted or who may have knowledge concerning my character, general reputation, personal characteristics or standard of living. I understand such information may also be obtained through direct or indirect contact with former employers, schools, financial institutions, landlords and public agencies or other persons who may have such knowledge. I understand that I have the right to receive notice about the nature and scope of any investigative consumer report requested within five days after the Company receives my request or five days after the investigative consumer report was requested, whichever is later. By checking the box, I indicate that I wish to receive further disclosure about the nature and scope of any Company request for an investigative consumer report. I acknowledge that I have received the attached summary of my rights under the Fair Credit Reporting Act I also understand that before I am denied employment based, in whole or part, on information obtained in the consumer report and/or investigative consumer report, I will be provided a copy of the report and a description in writing of my rights under the Fair Credit Reporting Act. I understand if I disagree with the accuracy of any information in the report, I must notify Carmel Country Club within five business days of my receipt of the report that I am challenging the accuracy of the information contained in this report with STERLING TESTING SYSTEMS, INC. and advise Carmel Country Club as to the basis of my challenge. In exchange for Carmel Country Club s consideration of my employment application, I agree not to file or pursue any complaints, claims or legal actions of any kind against STERLING TESTING SYSTEMS, INC. for providing the aforementioned information. I also agree not to file or pursue any complaints, claims or legal actions against Carmel Country Club or any of its employees, representatives, or agents arising out of or in any way related to conducting a background investigation. I am consenting that a photocopy of this authorization be accepted with the same authority as the original, and I specifically waive any written notice from any entity which may provide information based on this authorized request. I hereby consent to this investigation and authorize Carmel Country Club to procure a consumer report and/or investigative consumer report on my background as stated above from STERLING TESTING SYSTEMS, INC. In order to verify my identity for purposes of the background investigation I am voluntarily releasing my date of birth, social security and the other information below for my own benefit and fully understand that all employment decisions are based on legitimate non-discriminatory reasons. First Name Date of Birth (MM/DD/YYYY) Last Name Middle Name/Initial Other Names Known By Male Female Current Address #yrs at this address City State Zip Code Previous Address #yrs at this address City State Zip Code Driver s License No. State Social Security No. Signature Date Minnesota & Oklahoma applicants Only: I have the right to request a copy of the consumer report obtained by Carmel Country Club from Sterling Testing Systems, Inc. by checking the box below. Sterling Testing Systems, Inc. will mail the consumer report directly to me. Minnesota Applicants Only: I have the right to make a written request to the consumer reporting agency to provide me with a complete and accurate disclosure of the nature and scope of any consumer report obtained by Carmel Country Club from Sterling Testing Systems, Inc. I wish to receive a copy of the consumer report. (Check box only if you wish to receive a copy)

8 Revised 04.07

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