Two Harbors Employment - Grand Superior Lodge

Employment Application

Grand Superior Lodge is an equal opportunity employer committed to a policy of nondiscrimination with respect to race, color, religion, sex, national origin, and any other class protected by federal, state, or local law, including, but not limited to, medical condition, disability, marital status, age, sexual orientation, or pregnancy.

General Information
Date:
Full name:
Address:
City:
State:
Zip code :
Telephone number:
Date available for work:
Have you ever worked for Grand Superior Lodge or Caribou Highlands Lodge before?	Yes No
If yes, when?
Are you eligible/authorized to work in the United States?	Yes No
Are you age 18 or older?	Yes No
How were you referred to us? (If by newspaper ad, please give name)

Position Information
Type of work desired:
Salary desired:
Applying for:	Full-time Part-time Seasonal

Military Record
Have you ever served in the Armed Forces of the United States?	Yes No
If yes, complete the following:
Branch of Service:
Rank at Discharge:
State duties or specialized training:

Education
Type of School:
School Name:
School City/State:
Number of Years Completed:
Graduated:	Yes No
Course of Study or Major:

Type of School:
School Name:
School City/State:
Number of Years Completed:
Graduated:	Yes No
Course of Study or Major:

Do you plan to continue your education?:	Yes No
If yes, what area?:

Credentials and Skills
Describe your practical experience and/or training in the following areas:
Computer/Data Processing:
Years:
Months:

Accounting/Bookkeeping:
Years:
Months:

Sales:
Product Line Sold:
Years:
Months:

Typewriter/Word Processing :
Type:
WPM:
Years:
Months:

List your professional or technical licenses:

Background Information
Within the past seven years, have you been convicted of a crime other than misdemeanor traffic violations?	Yes No
If yes, please explain:
Note: Having a criminal record, other than misdemeanor traffic violations, does not necessarily mean you will be denied employment.
During the past five years, have you had any periods of unemployment?	Yes No
If yes, when?:
May we contact your current employer?:	Yes No
If not, specify reason:
During the past five years, have you ever been discharged, suspended, or asked to resign for any reason at any position?	Yes No
If yes, please explain:
For the purpose of verifying information on this application, have you ever worked or attended school under a different name at any of the organizations you have listed?	Yes No
If yes, please name:

Previous Employment Information
Employer:
Nature of Business :
Address:
Phone Number:
Your Title:
Superivsor:
Supervisor's Title:
May we contact your supervisor?	Yes No
Principle responsibilities, complete and specific:
Length of employment:	From To
Hours per week:
Last salary:
Reason for leaving:

Employer:
Nature of Business :
Address:
Phone Number:
Your Title:
Superivsor:
Supervisor's Title:
May we contact your supervisor?	Yes No
Principle responsibilities, complete and specific:
Length of employment:	From To
Hours per week:
Last salary:
Reason for leaving:

Please comment on how your prior education and experiences qualify you for the type of employment you are seeking. Detail any past responsibilities and achievements. Note any special course work, honors, activities, special projects or any other data that will assist us in considering your application for employment.


I hereby certify that the information given by me is true in all respects. I authorize Grand Superior Lodge and their representatives to contact my prior employers and all others for the purpose of verification of the information I have supplied and release same from any liability resulting from the information released. I authorize employers, schools and other persons named on this application to provide any information or transcripts requested. I understand that misrepresentation or omission of facts may result in refusal to hire or termination of employment. Employment with Grand Superior Lodge is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States. In the event that I am employed, I understand that I must comply with all company policies and rules. I further understand that employment and compensation can be terminated with or without cause or notice, at any time at the option of Grand Superior Lodge or the employee. This application is not a contract of employment between the applicant and Grand Superior Lodge. No words or actions of the company, including employment offers or terms and conditions of employment are intended to establish an implied or expressed employment contract. MY SIGNATURE IS EVIDENCE THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.
Full Name:
Date: