I. Personal Information
Last Name, First, Middle:  
DATE:
Present Address:
City:       State:     Zip Code:
Permanent Address:
(if different than above)
Social Security Number:     Telephone:

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver’s license, birth certificate, green card, etc.) within three (3) days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

Position applying for: None Office Assistant Sales Representative Service Technician Technician Apprentice

1. Is there any information we would need about your name or use of another name for us to be able to check your work record?
Please specify:

2. Do you have any relatives who are presently or have formerly been employed by SWIMKARE/SWIMCO?  Yes    No
3. How were you referred to SWIMKARE/SWIMCO? :

4. Have you ever been convicted of a felony? yes no  If yes, please explain:


II. Educational History

School Name/Location Years Completed Degree/Diploma

Elem/Jr. High:
High School:
College:
Technical/Training:
Other:

III. Employment Record - please include all employment for the last five (5) years. Most recent employer first.

COMPANY NAME:   
From: To:   
Address:
Phone:   Immediate Supervisor:
 Position/Title:
Starting Salary: Hourly Weekly Yearly      Ending Salary: Hourly Weekly Yearly

Reason for Leaving:

COMPANY NAME:   
From: To:   
Address:
Phone:   Immediate Supervisor:
 Position/Title:
Starting Salary: Hourly Weekly Yearly      Ending Salary: Hourly Weekly Yearly

Reason for Leaving:

COMPANY NAME:   
From: To:   
Address:
Phone:   Immediate Supervisor:
 Position/Title:
Starting Salary: Hourly Weekly Yearly      Ending Salary: Hourly Weekly Yearly

Reason for Leaving:

COMPANY NAME:   
From: To:   
Address:
Phone:   Immediate Supervisor:
 Position/Title:
Starting Salary: Hourly Weekly Yearly      Ending Salary: Hourly Weekly Yearly

Reason for Leaving:

COMPANY NAME:   
From: To:
Address:
Phone:   Immediate Supervisor:
Position/Title:
Starting Salary: Hourly Weekly Yearly      Ending Salary: Hourly Weekly Yearly

Reason for Leaving:

We will contact all of the employers listed on this application unless you specifically exclude them below.
Please list any employers you do not want us to contact and your reason for the exclusion:

IV. References - please do not include relatives or former employers.
Name:      Name Years Known:
Address:
Telephone:    Occupation:

Name:      Name Years Known:
Address:
Telephone:    Occupation:

Name:      Name Years Known:
Address:
Telephone:    Occupation:

Name:      Name Years Known:
Address:
Telephone:    Occupation:

V. Work Availability

If your application receives favorable consideration, when will you be available to begin work?

Do you have any objection to working overtime? Yes No
Can you work overtime without prior notice? Yes No
Can you work on Saturday? Yes No
Can you work on Sunday? Yes No
Can you travel if required by this position? Yes No

VI. Salary / Hourly Rate Requirements

If your application receives favorable consideration, what salary/hourly rate would you require? 
This must be completed. Hourly Weekly Yearly

I certify that all of the statements made by me on this application for employment are true, correct, and  complete to the best of my knowledge. I agree with this statement 
Yes     No

SWIMKARE / SWIMCO

Background Research Release

Please read this section carefully and acknowledge your understanding by signing your name in the space below.

I certify that all of the statements made by me on this application for employment are true, correct, and complete to the best of my knowledge.

1. Consent To Conduct Background Investigation

As a condition of and in consideration for SWIMKARE / SWIMCO consideration of this application, I give permission to SWIMKARE / SWIMCO to investigate my personal and employment history. I understand that this background investigation will include, but not be limited to, verification of all information on this application, as well as interviews with past employers. I further give permission to SWIMKARE / SWIMCO to conduct this investigation and to discuss the results of this investigation in connection with my application for employment.

2. Consent to Contact Past Employers

I give permission to SWIMKARE / SWIMCO to contact all employers listed in this application (except those specifically excluded) for references. I further give permission to all current or previous employers and/or managers or supervisors to discuss my relevant personal and employment history with SWIMKARE / SWIMCO, consent to the release of such information orally or in writing, and hereby release them from all liability and agree not to sue them for defamation or other claims based upon any statements they make to any representative of SWIMKARE / SWIMCO. I further waive all rights I may have under state law to receive a copy of any written statement provided by any of my former employers to SWIMKARE / SWIMCO. I further agree to indemnify all past employers for any liability they may incur because of their reliance upon this release.

3. Consent to Contact Government Agencies

I give permission to any agent, attorney or representative of SWIMKARE / SWIMCO to receive a copy of any information obtained in the file of any federal, state or local court, governmental agency, law enforcement agency or investigator concerning or relating to me. I further consent to the release of such information and waive any right under state law concerning notification of the request for a release of such information. In the event a state law does not provide for prospective employers to have access to information, I hereby delegate SWIMKARE / SWIMCO as my agent for receipt of information. I understand that the scope of this investigation will be limited to criminal and/or civil records that relate to my honesty, integrity and/or abilities.

4. Cooperation With Investigation

I agree to fully cooperate in SWIMKARE / SWIMCO background investigation, and to sign any waivers or releases that may be necessary to obtain access to relevant information. In the event that any former employer or federal, state or local governmental agency will not release reference information or criminal history information directly to the employer, I agree to personally request such information to the extent permitted by law.

5. Falsification Statement

I understand that any falsification or willful omission of fact made in this application or in connection with any background investigation my be sufficient grounds for rejection of this application, or, if discovered after an offer of employment, for immediate dismissal.

6. Employment "At Will"

In consideration of my employment, I agree to conform to the rules and regulations of SWIMKARE / SWIMCO, and my employment and compensation is "at will" in that they can be terminated with or without cause, and with or without notice, at any time, at the option of either SWIMKARE / SWIMCO or myself, except as otherwise provided by law. I understand that no manager or representative of SWIMKARE / SWIMCO, other than the General Manager of SWIMKARE / SWIMCO , has authority to enter into any agreement for employment for any specified period of time or to make any agreement or contract to the foregoing, and that any promises to the contrary will only be relied upon by me if they are in writing and signed by the General Manager of SWIMKARE / SWIMCO.

I have read this section carefully, by checking  I accept  below, I'm acknowledging my understanding of the above.
                            I Accept                     I Do Not Accept