Employment Application Please submit this simple contact form and we will contact you with our full application process. ABOUT YOU Your Name Address Telephone Best time to call Emergency Contact Name & Phone Number: Your Email (required) GENERAL Position Date you can start Times Available: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Specify any hours or days you cannot or will not work Upon request can you provide proof that you are authorized to work in the United States? YesNo Are you over 18 years of age? YesNo Have you ever worked for us? YesNo If so, when and where Have you ever applied to work with us before? YesNo If so, when and where How were you referred to us? List any friends, acquaintances, and relatives working at Little Whale and their relationship to you Education High School or GED Graduated? YesNo Post-Secondary School Post-Secondary School Graduated? YesNo Additional Education Type of degree/diploma/certificate Major/Subjects studied Other Employment History (List below the last three employers starting with the most recent first. For all dates, include Month and Year.) Employer Employer Address Employer Phone Date Started Date Ended Position May we contact? YesNo Brief description of your responsibilities Reason for leaving What did you like most about this job Employer Employer Address Employer Phone Date Started Date Ended Position May we contact? YesNo Brief description of your responsibilities Reason for leaving What did you like most about this job Employer Employer Address Employer Phone Date Started Date Ended Position May we contact? YesNo Brief description of your responsibilities Reason for leaving What did you like most about this job Add Another Employer Other Relevant Background Specify any special training and/or skills relevant to the job applied for Essential Requirements of the Position The essential requirements of the job are as follows: Able to work in 90-degree water for up to 4 hours. Able to lift up to 50 lbs. This includes moving equipment and physically assisting students in and out of the water. Able to work in a humid (degree ranges from 75-90) and noisy environment. Able to climb in and out of the pool. The essential requirements of the job for which you are applying are specified on the attached job description. Can you perform the listed essential requirements with or without reasonable accommodation? YesNo (Note: We comply with the ADA and state law and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.) Work / Volunteer References Give the names of three persons not related to you whom you have known at least one year and who can give information about your work qualifications. Reference Name Reference Address Reference Phone Reference Occupation Years Known How Known Give the names of three persons not related to you whom you have known at least one year and who can give information about your work qualifications. Reference Name Reference Address Reference Phone Reference Occupation Years Known How Known Give the names of three persons not related to you whom you have known at least one year and who can give information about your work qualifications. Reference Name Reference Address Reference Phone Reference Occupation Years Known How Known Other Have you ever stolen property or money from a former employer? YesNo Describe Have you ever damaged a former employer's property? YesNo Describe Do you carry a weapon on your person? YesNo If yes, do you have a permit to carry the weapon? YesNo Please Tell Us About Yourself (Write a summary of yourself. Include any experiences that you have had with children, babysitting, volunteering, siblings, etc.) Statement I hereby certify that all information contained in this application is true and correct to the best of my knowledge. I further certify that I have not knowingly withheld any information that may adversely affect my chances for employment. I understand that any error or omission of information may result in denial of employment or termination at any time. I authorize all my current and former employers and their employees, past or present, to give Little Whale Swim School any and all information concerning my employment history and any pertinent information they may have, personal or otherwise. I also authorize that all my former schools may give Little Whale Swim School any or all information concerning my education. I also authorize all the references that I have provided to give any information to Little Whale Swim School that they consider relevant. I waive all privacy interests in such information. I understand that if I receive a conditional offer of employment, at Little Whale Swim School's discretion, Little Whale Swim School will require a criminal history background check conducted by a background check provider, in accordance with applicable law. In such an event, Little Whale Swim School will provide a separate authorization form for me to sign. Further, to the maximum extent that can be waived under law, I release all the sources referenced above (and all their employees, officers, directors and agents) and Little Whale Swim School (and its employees, officers, directors and agents) of all claims and liability for any damages resulting from their furnishing any information, whether I agree or disagree with the content of the disclosed information. Thus, I understand that if any one of the above sources discloses information which I believe to be erroneous, I cannot bring any legal action against that source or Little Whale Swim School regarding the disclosure of the information. In this regard, I waive any and all benefits associated with California Civil Code Section 1542, which provides: "General Release/Claims Extinguished. To the fullest extent permitted by law, a general release does not extend to claims which the creditor does not know or suspect to exist in his/her favor at the time of executing the release, which if known by him/her must have materially affected his/her settlement with the debtor." If employed, I understand that my employment can be terminated with or without cause, at any time, and for any reason, or no reason, at the option of either Little Whale Swim School or myself. I understand that no one, other than an officer of Little Whale Swim School has any authority to enter into an agreement for employment for a specified period of time, or to make any agreement contrary to the foregoing. Any agreement entered into by an officer can only be made in writing signed by him/her and the employee. I understand that the issuance of this Application does not indicate that there are any positions open. Acknowledge: YesNo Signature: 39643
