Name

Prefix First Last Suffix

Home Phone #

Cell/Office Phone*

Email

Address*

Street Address City State ZIP Code

Position Desired*

Date Available*

Salary Requirements*

List the name(s) of anyone related to you who is a CGC employee. Separate each name using commas.

Referred By

Do you know of any reason why you cannot perform the essential functions of the job applied for, with or without reasonable accommodations?*

Yes
No

If yes, please explain.*

Some positions may require weekend, night and/or overtime work. Are there any days/hours you are NOT available to work?*

Yes
No

Please list any days/hours you are NOT available to work.

Education/Training

1

School Name

City, State

Date Attended From:

To

Area of Study or Major

Degree

2

School Name

City, State

Date Attended From:

To

Area of Study or Major

Degree

3

School Name

City, State

Date Attended From:

To

Area of Study or Major

Degree

Licensing & Certifications

License/Certification 1

Expiration Date

Issued By

License/Certificate #

License/Certification 2

Expiration Date

Issued By

License/Certificate #

Have you ever been discharged or asked to resign from a position?*

Yes
No

If yes, please explain:*

Why are you now seeking a change in employment?*

Have you ever been convicted of a crime, excluding minor traffic offenses?*

Yes
No

If yes, please state offense, date, court, disposition of the case and any rehabilitation:*

Employment History

1

Current or last Employer

Current or Last Employers Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Supervisor Name

May We Contact

Yes
No

Date of hire

End Date

Pay Rate

Job Title

Reason for leaving

Description of job duties

2

Do you have another employer to add?*

Yes
No

Previous Employer*

Current or Last Employers Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Supervisor Name*

May We Contact*

Yes
No

Date of hire*

End Date*

Pay Rate*

Job Title*

Reason for leaving*

Description of job duties*

3

Do you have a third employer to add?*

Yes
No

Previous Employer*

Employers Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Supervisor Name*

May We Contact*

Yes
No

Date of hire*

End Date*

Pay Rate*

Job Title*

Reason for leaving*

Description of job duties*

4

Do you have a fourth employer to add?*

Yes
No

Previous Employer*

Current or Last Employers Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Supervisor Name*

May We Contact*

Yes
No

Date of hire*

End Date*

Pay Rate*

Job Title*

Reason for leaving*

Description of job duties*

Is there anything else that you would like us to know about your skills or experience?

Pre-Employment Statement of Applicant: Please read before signing

I certify that the statements I have made in this application are true and hereby grant Cobb Galleria Centre permission to verify the accuracy and completeness of this information. I understand and agree that if I am accepted for employment, I will be employed on an at-will basis, and that my employment may be terminated by me or by this company at any time.

I understand and agree that as a condition of my employment, I am waiving my right to a jury trial in any action or proceeding related to my employment with Cobb Galleria Centre. I also understand and agree that as a condition of my employment, I am waiving my right to be a member in a class action in any action or proceeding related to my employment with Cobb Galleria Centre. I understand that I am waiving my right to a jury trial and to participate in a class action voluntarily and knowingly, and free from duress and coercion.

I fully understand that Cobb Galleria Centre employs only U.S. citizens and property authorized aliens, and that should I become employed, federal law requires me to furnish Cobb Galleria Centre proof of my identity and employment authorization, and to sign a statement under penalty of perjury verifying my eligibility for employment as a citizen or national of the United States or an otherwise employable alien.

I hereby authorize Cobb Galleria Centre to conduct a national background investigation on me to obtain any criminal history record information pertaining to me, which may be in the files of any state or local criminal justice agency. I understand that Cobb Galleria Centre shall not be violating my right of privacy in any manner by conducting the national background investigation.

I understand that this application will be considered for sixty (60) days. A new application must be completed for consideration after sixty (60) days.

Signature*

Disclosure Regarding Background Investigation

The Cobb-Marietta Coliseum & Exhibit Hall Authority (“the Company”) may obtain information about you from a third party consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report is an employment history or verification. These searches will be conducted by The Orsus Group, 3155 West Big Beaver, Suite 216, Troy, MI 48084, 877-575-1476, www.theorsusgroup.com. The scope of this disclosure is allencompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment to the extent permitted by law. I acknowledge that I have received and understand the disclosure regarding background investigation.

I have read the background investigation disclosure (sign name)*

Acknowledgment and Authorization for Background Check

I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION provided by Cobb-Marietta Coliseum & Exhibit Hall Authority (“the Company”) and certify that I have read and understand this section. I acknowledge receipt of a copy of the SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand this document. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the Company at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by The Orsus Group, 3155 West Big Beaver, Suite 216, Troy, MI 48084, 877-575-1476, www.theorsusgroup.com, and/or the Company itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original. New York applicants only: Upon request, you will be informed whether or not a consumer report was requested by the Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency identified above directly. By signing below, you acknowledge receipt of Article 23-A of the New York Correction Law Washington State applicants only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. Minnesota and Oklahoma applicants only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the Company. □ California applicants only: Under California Civil Code section 1786.22, you are entitled to find out what is in the CRA’s file on you with proper identification, as follows:  In person, by visual inspection of your file during normal business hours and on reasonable notice. You also may request a copy of the information in person. The CRA may not charge you more than the actual copying costs for providing you with a copy of your file.  A summary of all information contained in the CRA file on you that is required to be provided by the California Civil Code will be provided to you via telephone, if you have made a written request, with proper identification, for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to you.  By requesting a copy be sent to a specified addressee by certified mail. CRAs complying with requests for certified mailings shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the CRAs. “Proper Identification” includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if you cannot identify yourself with such information may the CRA require additional information concerning your employment and personal or family history in order to verify your identity. The CRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who must furnish reasonable identification. A CRA may require you to furnish a written statement granting permission to the CRA to discuss your file in such person’s presence. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law. □

I acknowledge and authorize a background check (sign name)*

Applicant's Name*

Applicant's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Upload Resume

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Employment Form

Employment Application

Education/Training

1

2

3

Licensing & Certifications

Employment History

1

2

3

4

Pre-Employment Statement of Applicant: Please read before signing

Disclosure Regarding Background Investigation

Acknowledgment and Authorization for Background Check