Personal Information
Full Name
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Please enter your full name; First Name, Middle Initial, Last Name

Address
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City
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State
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Zip
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Phone
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Secondary Phone
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Email
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Position(s) applying for

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Please check all that apply

Have you worked for Wild Mountain before?
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If so, when?
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Department
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Manager
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Are you 18 or older?
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If not, what is your date of birth?
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Education
School most recently attended
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Graduated
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Degree
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Availability
What days and hours are you available to work? (Specify approximate times for each day or use “any” if applicable or “OP” for opening shift and “CL” for closing shift.)
Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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Number of Days/Hours a week you are looking to work:
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Professional Reference
Company Name
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References

Phone Number
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Dates of Employment
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Supervisor
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Address
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Job Description
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Wage
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Reason for Leaving
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Professional Reference
Company Name
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References

Phone Number
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Dates of Employment
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Supervisor
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Address
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Job Description
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Wage
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Reason for Leaving
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Personal Reference
Name
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Phone Number
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Relation to you
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Time Known
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Do you have any health problems or disabilities that would affect your employment?
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If so, please explain:
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Please provide us with any additional information that you feel may be relevent to your employment here:
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APPLICANT’S STATEMENT Please Read Before Signing 1. I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge and agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if dismissal if discovered at a later date. 2. I authorize persons, schools, current employer (if applicable) and previous employers and organizations named in this application (and accompanying resume, if any) to provide Wild Mountain with any relevant information, personal or otherwise, including grade transcripts, that may be required to arrive at an employment decision, and I release all parties, including Wild Mountain, from any liability for any damages that may result from furnishing such information. 3. In consideration of employment, I agree to conform to the rules and regulations of Wild Mountain, and my employment and compensation can be terminated, with or without notice, at any time, at the option of either the Company or myself.
I have read the above statement(*)
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Initials(*)
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