Employment Application Step 1 of 10 10% Name* First Last Date* Date Format: MM slash DD slash YYYY Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Position DesiredHow did you learn about us?*What kind of position are you applying for? Part Time Full Time How many hours do you expect to work each week?*Expected Pay Range Desired*Are you willing to work on the weekends?* Yes No When will you be available to begin work?*Do you expect to work here for at least one year? (If no, please explain...)* Educational Experience High SchoolSchool Name / Course of Study / # of Years Completed*Have you graduated High School?* Yes No CollegeSchool Name / Course of Study / # of Years CompletedHave you graduated? Yes No School Name / Course of Study / # of Years CompletedHave you graduated? Yes No Work Availability For the following days of the week, what times are you NOT available to work?Monday* Tuesday* Wednesday* Thursday* Friday* Saturday* Sunday* Answer the following questions.Do you have any injuries or conditions that will prevent you from doing any aspect of the position applied for?*Have you ever been convicted for any crime including sex-related or child abuse related offenses?*Describe any awards you have received, any special skills, etc.*Describe any interests, activities, or hobbies you might have*Do you have any activity that might conflict with your ability to report to work as scheduled? (i.e. sports, school, another job)*Our hours vary from week to week and occasionally you may be asked to stay late, leave early, or come in on your day off. Do you foresee any problems with this?*Are you legally eligible to work in the United States?* Yes No Are you now, or have you ever been Safety Certified CPR Certified Neither When does your Safety certification expire?When does your CPR certification expire? Former Employers (Please start with most recent) Employer #1Name and Address of EmployerStart Date Date Format: MM slash DD slash YYYY End Date (if still employed, put today's date) Date Format: MM slash DD slash YYYY Salary / Hourly WagePositionReason for Leaving Employer #2Name and Address of EmployerStart Date Date Format: MM slash DD slash YYYY End Date (if still employed, put today's date) Date Format: MM slash DD slash YYYY Salary / Hourly WagePositionReason for Leaving Employer #3Name and Address of EmployerStart Date Date Format: MM slash DD slash YYYY End Date (if still employed, put today's date) Date Format: MM slash DD slash YYYY Salary / Hourly WagePositionReason for Leaving Are you currently employed?* Yes No May we contact your current employer? Yes No Is it your intent to continue in your current job(s) if you work here? Yes No Please account for any periods of unemployment during the past 3 years.Which of those jobs listed above did you enjoy the most? Why?Which of those jobs listed above did you enjoy the least? Why?Why would you like to work for our Gym?*What characteristics do you have that would make you a valuable employee to have?*Do you have any experience working with or around children? (Please explain)* References (NOT Relatives) Reference 1Name*Phone*Business Association*Years Acquainted* Reference 2Name*Phone*Business Association*Years Acquainted* Reference 3Name*Phone*Business Association*Years Acquainted* Please describe how you would handle an irate parent.*It’s a slow day at the gym, and there is time before more classes begin to come in. What do you do with your free time?*What do you think is the most important goal to achieve in a business such as ours?* List the most difficult skills you can do on the following equipment:Beam-Bars-Tumbling-Trampoline- Sample Lesson PlanPlease create a Lesson Plan for: BeamPlease create a Lesson Plan for: BarsPlease create a Lesson Plan for: Floor (Tumbling)Please create a Lesson Plan for: TrampolinePlease create a Lesson Plan for: Tumble Track “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 listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause.”Signature*Printed Name*Date* Date Format: MM slash DD slash YYYY