Application for Employment - Omaha Country Club
In order to provide equal employment opportunities to all individuals, employment decisions will be based on merit, qualifications, and abilities. Omaha Country Club does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristics protected by law. Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accomodation to the application and/or interview process should notify a representitive of the Human Resources Department.
Referral Source
Name of Source (if Applicaple)
Personal Information
Position(s) applied for
Date of Application
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First Name
Last Name
Address
City
State
Zip Code
Phone Number
Cell/Beeper/Other Phone
Last 4 digits of your Social Security #
May we contact you at work
If yes, work number and best time to call
If you are under 18, and it is required, can you furnish a work permit?
If no, please explain
Can you success perform the essential functions of the job for which you are applying
If no, please explain
Have you submitted an application here before?
If yes, give dates
Have you ever been employed here before?
If yes, give dates
Are you legally eligible for employment in this country?
Date available for work
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Type of employment desired
Are you able to meet the attendance requirements for the position
Are you related to any current employee or member of the Omaha Country Club
If yes, who
Will you work overtime if required
If no, please explain
Legal History
Have you ever been bonded
Have you ever been convicted of a misdemeanor in the last seven (7) years
Have you ever been convicted of a felony
If yes, please explain (Conviction does not necessarily be a bar to employment. Each instance and explaination will be considered in relation to the position for which you are applying.)
Driver's License number, if an essential job function
State
Education Background (if job related)
A. List any three (3) schools attanded, starting with most recent. B. List number of years completed. C. Indicate degree or diploma earned. D. GPA or Class Rank. E. Major field of study. F. Minor field of study.
School
Years Completed
Degree/Diploma
GPA Class Rank
Major
Minor
School
Years Completed
Degree/Diploma
GPA Class Rank
Major
Minor
School
Years Completed
Degree/Diploma
GPA Class Rank
Major
Minor
References
List name and telephone number of three business/work references who are not related to you. If not applicable, list three school or personal references who are not related to you.
Name of Reference
Telephone Number
Years Known
Name of Reference
Telephone Number
Years Known
Name of Reference
Telephone Number
Years Known
List special accomplishments, publications, awards, etc. (You may exclude membership which reveal sex, race, religion, national origin, age, color, or disability.
Organization
Office Held
Organization
Office Held
Organization
Office Held
List any additional information you would like us to consider.
List any additional information you would like us to consider
Employment History
Provide the following information for your past and current employees, assignments or volunteer activities, starting with the most recent (use additional sheets if necessary). Explain any gaps in employment in comments section below.
Employer
Job Title
Employed from
Employed to
Address
Telephone
Immediate supervisor and title
Reason for leaving
Starting hourly rate/salary
Hourly rate/salary per
Ending hourly rate/salary
Hourly rate/salary per
Summerize work performed and job responsibilities
May we contact for reference?
Employer
Job Title
Employed from
Employed to
Address
Telephone
Immediate supervisor and title
Reason for Leaving
Starting hourly rate/salary
Hourly rate/salary per
Ending hourly rate/salary
Hourly rate/salary per
Sumerize work performed and job responsibilities
May we contact for reference?
Employer
Job Title
Employed from
Employed to
Address
Telephone
Immediate supervisor and title
Reason for leaving
Starting hourly rate/salary
Hourly rate/salary per
Ending hourly rate/salary
Hourly rate/salary per
Comments
(include explaination of any gaps in employment)
Skills and Qualifications
Summerize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Please read and understand this statement before signing your application:
I certify that all the information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.

I authorize the Omaha Country Club to contact and obtain information about my previous employers, educational institutions and 'references' I provided, and any other party necessary to verify the accuracy of information disclosed in this application, a related employment resume or a personal interview. Based on your position, we may also require a criminal / credit check.  To assist in the processing of my Application, I waive all rights and claims I may otherwise have against the Omaha Country Club or it's representatives, for seeking, and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.

All employees are notified that smoking is prohibited in this entire facility.

The Omaha Country Club does not unlawfully discriminate in employment and no questions on this application are used for this purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.

This application will expire in 30 days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new employment application.

If I am hired, I understand that I am free to resign at any time, with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or defined duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurance to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

I understand it is this policy of the Omaha Country Club not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.
I represent and warrant that I read and fully understand the forgoing and seek employment under these conditions.
Date
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