Job Application

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ROCHESTER SENIOR CENTER FOUNDATION
FLAMINGO BINGO    EMPLOYMENT APPLICATION

Date__________________

PERSONAL (Please answer every question in Ink)                              

Name

(last name                                        first name                                      middle name)

SS #

Home Phone #:

Daytime Phone #:

Street Address

City, State ZIP

Have you ever been employed here before?      _____Yes     _____ No

Have you ever applied here before?   _____Yes     _____ No

Are you 18 years of age?    _____ Yes    _____ No          If under 18, give birthdate:

Position applying for:

_____ Full Time  _____ Part-time  _____ Summer Only

Pay desired?

Date Available to start:

Will you work overtime if asked?    _____ Yes     _____ No

How were you referred to us?

Are you personally acquainted with any person employed by The Foundation or Flamingo Bingo who is not related to you?         _____ Yes    _____ No      If yes, give name(s):

Are you related to any officer, director, or employees of RSCF or Flamingo Bingo?  _____ Yes    _____ No

If yes, give name(s):

EDUCATION

High School Year Completed:

9       10        11         12

Year Graduated:

College Year Completed

1        2          3           4      +

Year Graduated:

University Name:

Other education or training:

EMPLOYMENT HISTORY

Employment Dates:

Job title / description:

Employer Name:

Address:

Name of Supervisor:

Telephone Number:

Pay Rate:

Reason for Leaving:



Employment Dates:

Job title / description:

Employer Name:

Address:

Name of Supervisor:

Telephone Number:

Pay Rate:

Reason for Leaving:


Employment Dates:

Job title / description:

Employer Name:

Address:

Name of Supervisor:

Telephone Number:

Pay Rate:

Reason for Leaving:

MILITARY

(Complete this section if you served in the US Armed Forces)

Branch of Service:

Duties:

Period of Active Duty:

from Mo _____  Yr _____

to     Mo _____  Yr _____

Rank at discharge:

Date of final discharge:

Special training / notes:

MISCELLANEOUS

Any Physical limitations which inhibit you in performance of certain jobs?       _____ Yes    _____ No

If Yes, describe limitations:


The position for which you are applying is one which requires employees who are honest and trustworthy.  A dishonest answer to the following question will lead to immediate dismissal.  An affirmative response is subject to further review and inquiry.

Have you ever been convicted of a criminal offense involving dishonesty or breach of trust (including but not limited to robbery, embezzlement, forgery, perjury, tax evasion, etc)?            _____Yes        _____No.


If yes, please explain:


PLEASE READ BEFORE SIGNING

ROCHESTER SENIOR CENTER FOUNDATION’S bingo hall does not discriminate in hiring for employment on the basis of race, color, religious creed, national origin or ancestry, sex, age, handicap, marital status, economic status, class, physical characteristics or political beliefs.  No questions on this application are intended to secure information to be used for such discrimination.

This application will be given every consideration but its receipt does not imply that the applicant will be employed.

“I voluntarily give RSCF’s bingo hall  the right to make a thorough investigation of my past employment and job-related activities.  If I am employed by Rochester Senior Center Foundation’s bingo hall, I will comply with all rules and regulations as set forth in RSCF’s policy manual and other communications distributed to all employees.

I further understand that any false answers or statements made by me on this application will be sufficient grounds for immediate discharge.”

Dated______________                                  By_____________________________________
Signature of Applicant
Dated______________                                  By_____________________________________
Flamingo Bingo Gambling Manager