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Application For Employment

Fields marked with an * are required.

Xtreem Family Fun is an equal opportunity employer dedicated to a policy of nondiscrimination in employment upon any basis, including race, color, creed, religion, age, sex, national origin, ancestry, marital status, or the presence of any physical or mental condition or disability. In reading and answering the following questions, please keep in mind that these questions are not intended to imply any limitations, illegal preferences, or discrimination based upon any non-job related information.

Last Name * First Name * Middle Initial
Address *
City * State * Zip Code *
Telephone * Cell phone Email
Are You Over 18 Years Of Age? * Yes No
Other Names Under Which You Have Been Previously Employed
Status Desired Full Time Part Time Weekends Overtime (If Required)
Position Desired Salary Desired Date You Can Start / /
Hour Available (Indicate AM/PM)     Mon-Fri To    Sat To    Sun To
Are You Currently Employed? Yes No
May We Contact Your Current Employer? Yes No
Have You Ever Been Employed By Xtreem Family Fun? Yes No
If Yes, When And Where?
List Names Of Relatives, Friends Or Acquaintances Currently Employed At Xtreem Family Fun
Do You Have A Valid Drivers License? * Yes No      If Yes, #
Can You, After Employment, Submit Verification Of Your Legal Right To Work In The United States? * Yes No
Education
Type of School Name and Location
of School		 # of
Years		 Major Graduate
Y or N		 Diploma
Received?
High School Yes No Yes No
Business/Trade School Yes No Yes No
College or University Yes No Yes No
References
List two past supervisors and one person who is not related to you who have knowledge of your qualifications for the position for which you are applying.
Name Title/Relationship Address
(street, city, state, zip code)		 Phone
Number		 Occupation

Are You Currently Or Were You Previously In The Military? List Brance (Including Reserves)
Have You Ever Been Convicted Of A Crime (Misdemeanor Or Felony)? A Conviction Will Not Necessarily Disqualify You From Employment: Failure To Disclose Can Be Grounds For Termination. * Yes No
If Yes, Please Explain Fully. State The Nature Of The Offense, Date And Location The Offense Took Place:
EMPLOYMENT RECORD
From: Mo Yr To: Mo Yr
Business Name Phone #
Address City State Zip
Job Title Duties
Supervisor Title
Rate Of Pay Per
Reason For Leaving
From: Mo Yr To: Mo Yr
Business Name Phone #
Address City State Zip
Job Title Duties
Supervisor Title
Rate Of Pay Per
Reason For Leaving
From: Mo Yr To: Mo Yr
Business Name Phone #
Address City State Zip
Job Title Duties
Supervisor Title
Rate Of Pay Per
Reason For Leaving
From: Mo Yr To: Mo Yr
Business Name Phone #
Address City State Zip
Job Title Duties
Supervisor Title
Rate Of Pay Per
Reason For Leaving
UNEMPLOYMENT HISTORY
Please Account For Any Time You Were Not Employed In The Last Seven Years, After Leaving School. (You Need Not List Any Unemployment Periods Of One Month Or Less)
Time Period Reason For Unemployment
Have You Ever Been Discharged Or Asked To Resign From A Job? Yes No
If Yes, Why?    
Whom Should We Contact In An Emergency? Phone #

I declare that the information provided by me on this application, or any other documents filled out in connection with my employment, is complete and true to the best of my knowledge. I understand that any misrepresentation or omission on this application may preclude an offer of employment or withdrawal of an employment offer or may result in my discharge from employment if I am already employed at the time the misrepresentation or omission is discovered. If employed by Xtreem Family Fun, Inc. and in consideration of my employment, I agree to abide by the rules and regulations of Xtreem Family Fun, Inc. and agree that my employment and compensation can be terminated at will, with or without cause, with or without notice, at any time, either at my option or at the option of Xtreem Family Fun, Inc.

I authorize the investigation of all statements contained in this application. I also authorize the company to contact my present employer (unless otherwise noted in this application), past employers, and listed references and to provide information without limitations pertaining to my character, work history, background and qualifications. I waive any rights to privacy attached hereto. I release all parties and persons from any and all liability for any damages that may result from furnishing such information to Xtreem Family Fun, Inc. as well as from the use or disclosure of such information by Xtreem Family Fun, Inc. or any of its agents, associates, representatives or franchisor.

As a condition of my employment, I agree to arbitrate any and all disputes with the company pursuant to an arbitration agreement to be presented to me by the company.

I understand if selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States. I understand that all employment is contingent upon successful drug and/or alcohol screening and criminal background checks. Failure to keep my appointment for the drug/alcohol screening will result in withdrawal of a job offer.
Applicant Signature * Date *