HAC Employment Application

Applicant
Hockessin Athletic Club IS AN EQUAL OPPORTUNITY EMPLOYER. Applicants are considered for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy (including childbirth or related condition), physical or mental impairment, medical conditions associated with arrested cancer, marital status, or age and all other protected classes in any term, condition or privilege of employment to the extent required by law. To help us comply with government record keeping, reporting and other legal requirements, please complete this applicant information survey. We appreciate your cooporation and completion of this form is strictly voluntary on your part. This data is for periodic government reporting and will be kept in a Confidential File separate from the employment application. Note: all terms and definitions are in strict accordance with EEOC government reporting.
Date *

Month Day Year
Date
Position applied for *
Name *
Social Security No. *
Referral Source
How were you referred?
Referral Source Options:
- Newspaper
- Job Fair
- Hockessin Athletic Club Associate
- Other Publication
- School
- Walk-in
- Website
- Employment/Search Agency
- Friend
Cultural and Demographic Data
Please check here if you do not wish to disclose your cultural and demographic information

I wish to refrain from providing this information
Gender *

Male Female
Please Indicate: National Origin, Country of Origin or Ancestry
Check all that apply:

Caucasian/White (not of Hispanic origin) Black or African American (not of Hispanic origin) Asian (not Hispanic or Latino) Native Hawaiian or other Pacific Islander (not of Hispanic origin) American Indian or Alaskan Native (not of Hispanic origin) Hispanic or Latino
Extended Definitions
- Caucasian/White (not of Hispanic origin) – All persons having origins in any of the original people of Europe, North Africa or the Middle East.
- Black or African American (not of Hispanic origin) – All persons having origins in any of the black racial groups in Africa.
- Asian (not Hispanic or Latino) – All persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
- Native Hawaiian or other Pacific Islander (not of Hispanic origin) – All persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands .
- American Indian or Alaskan Native (not of Hispanic origin) – All persons having origins in any of the original peoples of North or South America, and who maintain cultural identification through tribal affiliation or community recognition.
- Hispanic or Latino – All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

Employment History
Begin with your most recent employment (1) and continue with all past employment.
Company
Job Title
Start Date of Employment

Month Day Year
Date
End Date of Employment

Month Day Year
Date
Address
Supervisor's Name
Supervisor's Work Phone Number

Area Code Phone Number
Reason for leaving
Description of job duties
Company
Job Title
Start Date of Employment

Month Day Year
Date
End Date of Employment

Month Day Year
Date
Address
Supervisor's Name
Supervisor's Work Phone Number

Area Code Phone Number
Reason for leaving
Description of job duties
Company
Job Title
Start Date of Employment

Month Day Year
Date
End Date of Employment

Month Day Year
Date
Address
Supervisor's Name
Supervisor's Work Phone Number

Area Code Phone Number
Reason for leaving
Description of job duties
Company
Job Title
Start Date of Employment

Month Day Year
Date
End Date of Employment

Month Day Year
Date
Address
Supervisor's Name
Supervisor's Work Phone Number

Area Code Phone Number
Reason for leaving
Description of job duties

Notification and Agreement
I certify that all answers given by me are true, accurate, and complete. I understand that the falsification, misrepresentation, or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or who discovered.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed. It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law. I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation. If hired, I agree to abide by all of the company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me, I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the company, has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the Owner or General Manager, or to make any agreement contrary to the foregoing. I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.
PLEASE READ BEFORE SIGNING
Applicant Signature *
Date *
Should be Empty: