Name*
First Name
Last Name
Address*
Street Address
Address Line 2
City
State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaPuerto RicoGuamAmerican SamoaU.S. Virgin IslandsNorthern Mariana Islands
ZIP Code
Phone Number*
Email*
Do you have any friends, relatives, or acquaintances who work for FLIPNOUT Xtreme?* YesNo
If hired, would you have reliable transportation to/from work?* YesNo
Are you of the age of 16 or older?* YesNo
If you are under age 18, do you have an employment/age certificate?* YesNo
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?* YesNo
Do you have a current Food Handler Safety Card issued by the Southern Nevada Health District?* YesNo
If hired, would you be willing to acquire a Food Handler Safety Card issued by the Southern Nevada Health District prior to your start date?* YesNo
Have you been convicted of or pleaded no contest to a felony within the last five years? YesNo
If hired, are you willing to submit to and pass a controlled substance test?* YesNo
Position Applying For:* AnyMonitorLaser TagFront DeskCafeShift Lead
Salary Desired:*
Part-Time work?* YesNo
Full-Time work?:* YesNo
Days/Hours Available* Indicate when you would be available to start and end each day. YesNo
Monday*
Tuesday*
Wednesday*
Thursday*
Friday*
Saturday*
Sunday*
If hired, on what date can you start working?*
MM
DD
YYYY
Are you available/willing to work weekends?* YesNo
Are you available/willing to work evenings?* YesNo
Are you able to perform the essential functions of the job for which you are applying, either with /without reasonable accommodation?* YesNo
High School Name*
Year of graduation (or expected graduation)*
Did you graduate?* YesNo
Did you earn a Diploma? GED?*
College / University Name
Number of years completed
Degree / diploma earned
Vocational School Name
List any skills and qualifications: Licenses, Skills, Training, Awards, etc.*
Do you speak, write or understand any foreign languages?* YesNo
Provide details about the last three positions you have held. Account for any gaps in employment during that period.
Are you currently employed?* YesNo
Name of Employer
Phone
Address
Length of Employment (Include Dates)
Position & Duties
Reason for Leaving
May we contact this employer for references? YesNo
List below three persons who have knowledge of your work performance within the last four years. Please include professional references only. If you have never been previously employed, include personal references.
First Name Last Name Phone Occupation Number of Years Acquainted
I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
Signature *
Date* (Click on the arrow to open the calendar)
Please be advised that all minors must have a waiver signed by their parent or legal guardian.Waiver is only good per location
