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Montgomery Inn Employment Application

Now Hiring in Columbus, Ohio!

PERSONAL INFORMATION

Last Name:		First Name:		Middle Name:
Present Street Address:
City:		State:		Zip:
If you are under the age of 21, state your age:				Email:
Home Phone:		Last 4 digits of SSN:		Expected Salary/Wage:
If hired, when could you start?			Hours per week available:
What days/nights?			Weekends?
Can you work overtime?	Yes No
What kind of work are you applying for?
What special qualifications do you have?
Do you have any transportation issues that would affect scheduling
Do you have any other obligations (work, school, etc) that would affect scheduling? If yes, how?			Yes No
Have you ever applied with Montgomery Inn before If yes, where and when?			Yes No
Have you ever worked for Montgomery Inn before? If yes, where and when?			Yes No
Who referred you to us?
Do you have any relatives working for this company If yes, who?			Yes No

EDUCATION

ELEMENTARY	# of Years Attended:	Degree/Major:
Name of School:	City:	State:

HIGH SCHOOL	# of Years Attended:	Degree/Major:
Name of School:	City:	State:

COLLEGE	# of Years Attended:	Degree/Major:
Name of School:	City:	State:

OTHER	# of Years Attended:	Degree/Major:
Name of School:	City:	State:

EMPLOYMENT HISTORY (Please list most recent position first)

Employer Name:	Start Date:	End Date:
Address:	City:	State:
Position Held:	List your duties:
Starting Wage:	Final Wage:	May we call?	Yes No
Supervisor:	Reason for Leaving:

Employer Name:	Start Date:	End Date:
Address:	City:	State:
Position Held:	List your duties:
Starting Wage:	Final Wage:	May we call?	Yes No
Supervisor:	Reason for Leaving:

Employer Name:	Start Date:	End Date:
Address:	City:	State:
Position Held:	List your duties:
Starting Wage:	Final Wage:	May we call?	Yes No
Supervisor:	Reason for Leaving:

Employer Name:	Start Date:	End Date:
Address:	City:	State:
Position Held:	List your duties:
Starting Wage:	Final Wage:	May we call?	Yes No
Supervisor:	Reason for Leaving:

MISCELLANEOUS

Is there any additional information regarding a change of your name or assumed name that will permit us to check your work record?
Have you ever been convicted of a felony? If yes, explain.		Yes No
Are you legally authorized to work in the United States?		Yes No
Do you know of any reason why you cannot perform the essential functions of the job for which you are applying, with or without reasonable accomodations? Please describe any accomodations required.		Yes No
Were you in the U.S. armed forces?		Yes No
If yes, what branches?
	What dates of duty?
	Rank at separation:
	Briefly describe your duties:

PLEASE READ THIS STATEMENT CAREFULLY

I hereby affirm that the information given by me on this application for employment is complete and accurate. I understand that any falsification or omission will be immediate grounds for dismissal. I authorize a thorough investigation to be made in connection with this application, including personal interviews with third parties such as neighbors, business associates, financial sources and a criminal record ssearch and/or credit check through the appropriate agency.

I further understand that it is a condition of my consideration for employment that I agree to submit to such future examinations, physical or other, as may be lawfully required by the company. The company will pay the reasonable cost of any such examination which may be required.

While I am employed by Montgomery Inn, I understand and agree that my employment and compensation is at will and can be terminated with or without cause at any time at the option of either Montgomery Inn or myself, unless modified by written agreement, signed by myself and the president of the company. No other person in the company, other than the president in writing, is authorized to change this agreement, and this agreement is the entire understanding between myself and Montgomery Inn and cannot be modified or affected by changes in rates of pay, position, or conditions of employment. I understand that neither the procedures, policies, nor manuals, etc. of Montgomery Inn can alter this employment agreement. I understand this agreement and have read it carefully before signing. I have also read and affirm as my own the above statements.

Applicant Name:

Today's Date:

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