Application for Employment

Step 1 of 4

FIRST NAME*

LAST NAME*

EMAIL*

PHONE*

CURRENT ADDRESS

STREET*

COUNTRY*

STATE*

CITY*

ZIP Code*

PREVIOUS ADDRESS

STREET*

COUNTRY*

STATE*

CITY*

ZIP Code*

DESIRED POSITION*

Employment Type*

Have you ever been terminated or asked to resign from any job?
If yes, please explain circumstances.*

IF YES, PLEASE DESCRIBE*

Step 2 of 4

PresenT or most recent employer*

Position Title*

Employed from*

Employed to*

Reason for Leaving*

Pay to start*

pay final*

PresenT or most recent Employer ADDRESS

STREET*

COUNTRY*

STATE*

CITY*

ZIP Code*

Step 3 of 4

Please explain fully any gaps in your employment history

Have you ever pled guilty or "no contest" to, or been convicted of a serious misdemeanor or felony? If yes, please give date and details*

Have you ever been terminated based upon, or resigned in response to, an accusation of inappropriate conduct toward a customer or co-worker?*

May we contact your current employer? If no please explain.

EXPLAIN*

Have you ever used another name? If so, what other names?*

names*

If hired, can you provide proof that you are authorized to work in the United States on an unrestricted basis?*

Are you capable of satisfactorily performing the essential job duties of the position, with or without reasonable accommodation, for which you are applying? (Please review the attached job description)*

Do you have adequate transportation to and from work?

Hours available (Note any school or employment schedules)

Please indicate any actual experiences, special training or qualification that you have that you feel is relevant to the position for which you are applying

3 professional supervisor references

NamePhoneTitle

Step 4 of 4

AUTHORIZATION*

I hereby authorize Hiatus Day Spa • Med Spa’s affiliate entities (collectively, “Hiatus”), to request and obtain information regarding my past activities and conduct for the purpose of evaluating my candidacy for employment with Hiatus. This information may include, but is not limited to, any and all records concerning my personal history, job performance and attendance, and results of any disciplinary action, arrests and convictions. I understand that Hiatus shall not seek any of my personal and confidential medical information. I release Hiatus Day Spa • Med Spa, including its affiliate entities, and any third parties who provide the requested information, from any and all liability arising from good faith compliance with this authorization.

Your resume was successfully submitted.
Thank you for your interest in Hiatus Spa!

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