Application for Employment                                    Pinecrest Lake Resort

                                                                                      421 Pinecrest Lake Road

                                                                                                            Pinecrest, California 95364

                                                                                                            (209) 965-3411

Date:_____________________                                            (209) 965-4032 fax

Personal Information

Name (Last, First, Middle): _________________________________________________________________

Address:______________________________________________________________________________________

City, State, Zip:______________________________________________________________________________

Phone Number:______________________________________________________________________________

Social Security Number:_____________________________    Referred By:__________________________

Employment Desired

Position:________________________________________________   Date you can start________________

Salary Desired:___________________           Are you Employed?  Yes       No

May we inquire of your present employer?           Yes         No

Have you applied to this company before?  Yes     No        

If yes, Date applied____________________________________   Position applied for________________

Education History

Name of School:                               Years attended:                Diploma?            Subjects Studied            

Elementary        ________________________________                ___________          ____________        _________________________

High School     ________________________________  ___________          ____________        _________________________

College                ________________________________                ___________          ____________        _________________________

Trade                    ________________________________                ___________          ____________        _________________________

Business, Correspondence

General Information

                                Subjects of Special Study/Research/Work or Special Training Skills:

__________________________________________________________________________________________________________________________________________________________________________________________________

                                U.S. Military Service__________________________________________________     Rank________________

Former Employers (List below last four employers, starting with last one first)

Month and Year:              From______________ To_______________ Salary__________________  Position ______________

Name and Address of Employer:_______________________________________________________________________________

Supervisors Name:_______________________________________________________ Reason for leaving__________________

Month and Year               From______________ To_______________     Salary__________________  Position ______________

Name and Address of Employer:_______________________________________________________________________________

Supervisors Name:_______________________________________________________ Reason for leaving__________________

Month and Year               From______________ To_______________     Salary__________________  Position ______________

Name and Address of Employer:_______________________________________________________________________________

Supervisors Name:_______________________________________________________ Reason for leaving__________________

Month and Year               From______________ To_______________     Salary__________________  Position ______________

Name and Address of Employer:_______________________________________________________________________________

Supervisors Name:_______________________________________________________ Reason for leaving__________________

References: (Give below the names of  three persons not related to you, whom you have known at least one year).

Name:____________________________________________          Address________________________________________________

Business:_________________________________________           Years Known:__________________________________________

Name:____________________________________________          Address________________________________________________

Business:_________________________________________           Years Known:__________________________________________

Name:____________________________________________          Address________________________________________________

Business:_________________________________________           Years Known:__________________________________________

Authorization:

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 statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization from such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Signature:___________________________________________________________     Date:____________________________