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.

Applicant's Name*

Applicant's Address*

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

Signature*

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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