EMPLOYMENT SCREENING FORM
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1 RICTLY PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER PARTY, THIS A Nam: EMPLOYMENT SCREENING FORM PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS Las Fs Mddl Psn Addss: Da: Numb S Cy Sa Zp How Long a s addss: Socal Scuy No: Tlpon: Employmn Dsd: TYPE OF SCHOOL Hg Scool Collg Bus o Tad Scool Pofssonal Scool Da of B: FULL-TIME ONLY PART-TIME ONLY FULL- OR PART-TIME EDUCATION & OTHER INFORMATION NAME OF SCHOOL Landscap o lad Consucon Expnc Masony o Conc Expnc Plumbng o Elccal Expnc Spcal Cfcaons o Tanng Psonal Ys PC Compu No Mac LOCATION (Compl malng addss) WORK EXPERIENCE O Sklls: NO OF YEARS COMPLETED MAJOR & DEGREE C o p y g B z I n c A l l g s s v d P o c d 1 Fou Sasons of Goga, LLC Employmn Scnng b y
2 EMPLOYMENT HISTORY Plas ls you wok xpnc fo pas fv yas bgnnng w you mos cn job Compl nfomaon blow w mos cn job ld If you w slf-mployd, gv fm nam Aac addonal ss f ncssay Job On Nam of Employ: Nam of Las Supvso Employmn Das Salay Compl Addss: Pon Numb: Rason fo Lavng (b spcfc): You Job Tl: Fom: Sa: Fnal: Ls jobs you ld, dus pfomd, sklls usd o land, advancmns o pomoons wl you wokd a s company Job Two Nam of Employ: Nam of Las Supvso: Employmn Das Salay Compl Addss: Pon Numb: You Job Tl: Fom: Sa: Fnal: Rason fo Lavng (b spcfc): Ls jobs you ld, dus pfomd, sklls usd o land, advancmns o pomoons wl you wokd a s company Job T Nam of Employ: Nam of Las Supvso: Employmn Das Salay Compl Addss: Pon Numb: You Job Tl: Fom: Sa: Fnal: Rason fo Lavng (b spcfc): Ls jobs you ld, dus pfomd, sklls usd o land, advancmns o pomoons wl you wokd a s company May w conac you psn mploy? Dd you compl s applcaon youslf? 2 Ys No Ys No Fou Sasons of Goga, LLC Employmn Scnng
3 MILITARY EXPERIENCE Hav you v bn n amd focs? Banc: A you now a mmb of Naonal Guad? Da End: Dscag Da: Duy Tl/Spcaly: Typ of Dscag: Hav you v bn convcd of a cm? CRIMINAL HISTORY If ys, xplan numb of convcon(s), nau of offns(s) ladng o convcon(s), ow cnly suc offns(s) was/w commd, snnc(s) mposd, and yp(s) of ablaon DRIVER HISTORY Dv Lcns# Sa of ssu: Hav you ad any moo vcl accdns? Expaon da: If ys, ow many? I s undsood and agd upon a any mspsnaon by m n s applcaon wll b suffcn caus fo cancllaon of s applcaon and/o spaaon fom mploy s svc f I av bn mployd Fumo, I undsand a I am f o sgn a any m, mploy svs g o mna my mploymn a any m, w o wou po noc I undsand a no psnav of mploy as auoy o mak any assuanc o conay I gv mploy g o nvsga all fncs and o scu addonal nfomaon abou m, f job lad I by las fom lably, mploy and s psnavs fo skng suc nfomaon and all o psons, copoaons, o oganzaons fo funsng suc nfomaon Applcan Sgnau: Da: 3 Fou Sasons of Goga, LLC Employmn Scnng
4 APPLICATION FORM WAIVER PLEASE READ CAREFULLY In xcang fo consdaon of my job applcaon by Fou Sasons of Goga, LLC (naf calld Company ), I ag a: N accpanc of s applcaon no subsqun ny no any yp of mploymn laonsp, n poson appld fo o any o poson, and gadlss of conns of mploy andbooks, psonnl manuals, bnf plans, polcy samns, and lk as y may xs fom m o m, o o Company paccs, sall sv o ca an acual o mpld conac of mploymn, o o conf any g o man an mploy of Fou Sasons of Goga, LLC, o ows o cang n any spc mploymn-a-wll laonsp bwn and undsgnd, and a laonsp canno b ald xcp by a wn nsumn sgnd by Psdn /Gnal Manag of Company Bo undsgnd and Fou Sasons of Goga, LLC may nd mploymn laonsp a any m, wou spcfd noc o ason If mployd, I undsand a Company may unlaally cang o vs bnfs, polcs and pocdus and suc cangs may nclud ducon n bnfs I auoz nvsgaon of all samns conand n s applcaon I undsand a mspsnaon o omsson of facs calld fo s caus fo dsmssal a any m wou any pvous noc I by gv Company pmsson o conac scools, pvous mploys (unlss ows ndcad), fncs, and os, and by las Company fom any lably as a sul of suc conac I also undsand a (1) Company as a dug and alcool polcy a povds fo p-mploymn sng as wll as sng af mploymn; (2) consn o and complanc w suc polcy s a condon of my mploymn; and (3) connud mploymn s basd on succssful passng of sng und suc polcy I fu undsand a connud mploymn may b basd on succssful passng of joblad pyscal xamnaons I undsand a, n conncon w oun pocssng of my mploymn applcaon, Company may qus fom a consum pong agncy an nvsgav consum po ncludng nfomaon as o my cd cods, caac, gnal puaon, psonal caacscs, and mod of lvng Upon wn qus fom m, Company, wll povd m w addonal nfomaon concnng nau and scop of any suc po qusd by, as qud by Fa Cd Rpong Ac As a condon of mploymn, I undsand a I mus povd a cfd copy of my cun DMV cod If I fal o povd a cfd copy of my cun DMV cod, Company wll oban a cfd copy, and all coss assocad w pocumn of sad cod wll b dducd fom fs (1 s ) payoll pod I undsand a, n conncon w oun pocssng of mploymn applcaon, Company may conac o sa and fdal agncs as ndd Any coss assocad w s backgound nvsgaons wll b bon by applcan and dducd n (1 s ) pay pod I fu undsand a my mploymn w Company sall b pobaonay fo a pod of nny (90) days, and fu a a any m dung pobaonay pod o af, my mploymn laon w Company s mnabl a wll fo any ason by pay Sgnau of Applcan: Da: Ts Company s an qual mploymn oppouny mploy W ad o a polcy of makng mploymn dcsons wou gad o ac, colo, lgon, sx, sxual onaon, naonal ogn, cznsp, ag o dsably W assu you a you oppouny fo mploymn w s Company dpnds solly on you qualfcaons Tank you fo akng m o compl s scnng and fo you ns n ou company 4 Fou Sasons of Goga, LLC Employmn Scnng
5 5 Fou Sasons of Goga, LLC Employmn Scnng
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