Application for Employment 165 Ward Avenue Winchester, VA  22602 Office: (540) 662-8010 Fax:     (540) 662-8464

Position applied for ­­­­­­­­­­­­­­­­­­­_________________________________
Social Security No. ________________________ (optional – may be required on other forms prior to employment.)
Full legal name ________________________________________________
                        Last            First            Middle
Address   _____________________________________________________
          _____________________________________________________
                City                        State                        Zip
Home Phone __________________________________
Cell Phone ____________________________________
Other Phone ___________________________________
E-mail Address _____________________________________________

EDUCATION:

a) Circle highest grade completed        1   2   3   4   5   6   7   8   9   10   11   12
b) If you did not complete high school, do you have a high school equivalency diploma? ___  YES ___ NO
c) Circle number of years of post high school education    1   2   3   4   5   6   7   
 

Name and Location of Institution	Degree Rec’d	Major or Specialty	Minor	Dates Attended
1.
2.
3.

EXPERIENCE:

Job Title ___________________________ Duties __________________________
     Employer __________________________         ____________________________
     Address   __________________________      ____________________________
     __________________________________          ____________________________
     ______ Phone ______________________          ____________________________
     Type of Business ____________________         ____________________________
     Immediate supervisor  ________________Number of people you supervised _____
               Title _________________________Equipment used ___________________
     Salary (start) __________ (finish) _______Reason for leaving _________________
     Dates (mo/yr) _________ (mo/yr) _______      ____________________________
     May we contact this employer ___ YES ___NO
The position was: ___ FULL TIME    ___ PART TIME  ___ 
                                     ____ HOURS/WK

Job Title ___________________________ Duties __________________________
     Employer __________________________         ____________________________
     Address   __________________________      ____________________________
     __________________________________          ____________________________
     ______ Phone ______________________          ____________________________
     Type of Business ____________________         ____________________________
     Immediate supervisor  ________________Number of people you supervised _____
               Title _________________________Equipment used ___________________
     Salary (start) __________ (finish) _______Reason for leaving _________________
     Dates (mo/yr) _________ (mo/yr) _______      ____________________________
     May we contact this employer ___ YES ___NO
The position was: ___ FULL TIME    ___ PART TIME  ___ 
                                     ____ HOURS/WK

Job Title ___________________________ Duties __________________________
     Employer __________________________         ____________________________
     Address   __________________________      ____________________________
     __________________________________          ____________________________
     ______ Phone ______________________          ____________________________
     Type of Business ____________________         ____________________________
     Immediate supervisor  ________________Number of people you supervised _____
               Title _________________________Equipment used ___________________
     Salary (start) __________ (finish) _______Reason for leaving _________________
     Dates (mo/yr) _________ (mo/yr) _______      ____________________________
     May we contact this employer ___ YES ___NO
The position was: ___ FULL TIME    ___ PART TIME  ___ 
                                     ____ HOURS/WK

REFERENCES:          

Name	Address	Phone	Relationship

May we contact all of your references? ___ YES ___ NO

Have you ever been convicted for any violation of law, including moving traffic violations. ___ YES  ___ NO – If yes, description:

_________________________________________________________________________________

Are you 18 years of age or older? ___ YES  ___ NO

Are you a U.S. citizen or an Alien authorized to work in the U.S. ___ YES  ___ NO

Are you employed now? ___ YES  ___ NO         
If so, may we contact your employer? ___ YES  ___ NO

Have you ever applied to this company before? ___ YES  ___ NO     WHEN? _________

When will you be available to start work? _______Month ________Day______Year
Check shifts that you would accept:
___ Morning ___ Day ___ Evening ___ Weekends ___ Holidays ___  Rotating

Are there any times or date ranges you could not work or hours would be limited?
___ YES  ___ NO    If yes, When? ______________________________________
_________________________________________________________________
_________________________________________________________________

License (to include driver’s), certificate or other authorization to practice a trade or profession.

Type	License Number	Granted by (licensing board)

Best skills and qualifications you possess for a position here:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

CERTIFICATION:

I hereby certify that all entries on this application for employment are true and complete.
I authorize Candy Hill Campground to perform a background check at any time.


Date ___________  Applicant Signature _____________________________________