Application for Employment

Fitness Repair Plus is an Equal Opportunity Employer. Required information is highlighted in red text.

Your Information Last Name: First Name: Middle Name:
Email:
Social Security Number:
Address 1: Address 2:
City: State: Zip code:
Phone:
Position you are applying for:
Are you at least 18 years of age? Yes No
Referral Source: Advertisement Agency Relative Walk-In Employee Other
Name of Employee:
Experience with machines and/or office equipment (e.g. Office - Computers - Maintenance):

Do you wish to work full-time? Full-time Part-time Temporary Summer
When can you start? (mm/dd/yy)
Will you work any shift? Yes No   If no, shift(s) you will work:
Are you willing to work overtime? Yes No
Are you willing to work on weekends? Yes No
Do you have a way of getting to work? Yes No
Have you ever been employed by Fitness Repair Plus? Yes No
If yes, please give data and reason for leaving:

Have you ever been convicted of a felony, including a crime of dishonesty and/or physical violence, within the past 10 years?
Yes No
(An affirmative answer will not automatically disqualify you from being considered as a candidate for employment.)
If yes, please explain:

Why are you seeking employment with Fitness Repair Plus?

What qualifications do you bring to this position?

Why should you be considered for this position?

Education
Number of years completed, elementary - college
Name of highschool last attended:   Graduated: Yes No
Address 1: Address 2:
City: State: Zip code:

College or University
Name & Addition
Course of Study Years Attended
From

To
Degree Date Received
Trade School /
Adult Education
Course of Study Years Attended
From

To
Degree Date Received
List other work experience and/or skills, knowledge, talents, business licenses or other job-related experiences not covered elsewhere:

Employment Record This portion of the application must be completed even if sumpelented by a resume. List most recent job first.
Employer: Phone: Employed From Employed To Starting Salary Ending Salary
Address 1: Address 2:
City: State: Zip code:
Position and Duties: Amount of last increase: Reason for leaving:
Employer: Phone: Employed From Employed To Starting Salary Ending Salary
Address 1: Address 2:
City: State: Zip code:
Position and Duties: Amount of last increase: Reason for leaving:
Employer: Phone: Employed From Employed To Starting Salary Ending Salary
Address 1: Address 2:
City: State: Zip code:
Position and Duties: Amount of last increase: Reason for leaving:
Employer: Phone: Employed From Employed To Starting Salary Ending Salary
Address 1: Address 2:
City: State: Zip code:
Position and Duties: Amount of last increase: Reason for leaving:
May we contact your present employer? Yes No

Business References (Business references do not include family members.)
Name Occupation Street City State Phone
1.
2.
3.
4.

Status Federal Law required Fitness Repair Plus to verify that all of its employees are authorized to be employed in the United States
Are you presently authorized to be employed by any employer in the United States on a full-time basis? Yes No
If no, what is you present immigration status?
If the job for which you are making application is a delivery driver position, please answer the following questions. If not, disregard section.
Do you have a valid driver's license? Yes No     If Yes, what state Identification Number:

Statement of Application
  1. I hereby authorize the Company to investigate the foregoing statements, references and previous employers and I further authorize the release of any such information without liability.
  2. I certify that the foregoing information is correct and complete.
  3. I understand that any false statements in this application will be sufficient cause for discharge or not hiring.
  4. I understand that any job offer is contingent upon successfully completing a physical examination, drug screen, and background investigation for job placement and I agree to such examination.
  5. I understand that any job offer is contingent upon verification of legal employment status and I agree to provide adequate documentation.
  6. I understand that my employment can be terminated, with or without cause, at any time at the discretion of either the company or myself and accept the status of an employee-at-will. I understand that no management official other than the president of the company has any authority to enter into any agreement contrary to the foregoing or make any oral assurances or promise of continued employment.

I have read and agree to the terms above

Job Placement Physical includes Drug Screening
All Qualified Applicants Will Receive Consideration for Employment Without Regard to
Race, Religion, Color, Sex, National Origin, Age, Military Background,
Disability, or Marital Status.