Employment Application

The Patch Lodge
801 State Ave.
Warroad, MN 56763

Phone: (218) 386-2723
Email: info@thepatchlodge.com

Employment Application

Date
MM slash DD slash YYYY
PERSONAL
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Best Daytime Phone
Position Desired
Available to Start
When would you be available to begin work?
Shift Availability
This position requires both day, night, and weekend shifts. Would you be available to work these shifts (with flexibility)?
- Yes
- No
Shift Availability Notes
EMPLOYMENT
List most current employer first, including U.S. Military Service.
Employer
Position
Dates of Employment - From
Employed From:
Dates of Employment - To
To:
Salary
Supervisor
Telephone
Reason for Leaving
May We Contact
May we contact this employer?
- Yes
- No
Employer
Position
Dates of Employment - From
Employed From:
Dates of Employment - To
To:
Salary
Supervisor
Telephone
May We Contact
May we contact this employer?
- Yes
- No
REFERENCES
Give the name of one person not related to you.
REFERENCES: Name
Phone
Relationship
Were You Referred by Someone?

REFERRAL
May we thank anyone for referring you to us?
- Yes
- No
Referred By
This application for employment will be kept on file for one year. Consideration for employment after this year requires a new application.

APPLICANT’S CERTIFICATION AND AGREEMENT

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release The Patch Lodge from the result of obtaining and having an employment decision based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules, and regulations of employment of The Patch Lodge. However, I further understand that neither the policies, rules, and regulations of employment or anything said during the interview process shall be deemed to constitute the terms of offer for an indefinite duration and at will and that either I or The Patch Lodge may terminate my employment at any time with or without notice or cause.
Signature
Please sign by typing your full name:
Date
Today's date:
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Employment Application

Employment Application

Employment Application

PERSONAL

EMPLOYMENT

REFERENCES

REFERRAL