Personal Information
First Name
Last Name
Street Address
Address Line 2
City
State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands
ZIP Code
Phone Number*
Email*
Do you have any friends, relatives, or acquaintances who work for FLIPNOUT Xtreme?* Yes No
If hired, would you have reliable transportation to/from work?* Yes No
Are you of the age of 16 or older?* Yes No
If you are under age 18, do you have an employment/age certificate?* Yes No
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?* Yes No
Do you have a current Food Handler Safety Card issued by the Southern Nevada Health District?* Yes No
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?* Yes No
Have you been convicted of or pleaded no contest to a felony within the last five years? Yes No
If hired, are you willing to submit to and pass a controlled substance test?* Yes No
Position and Availability
Position Applying For:* Any Monitor Laser Tag Front Desk Cafe Shift Lead
Salary Desired:*
Part-Time work?* Yes No
Full-Time work?:* Yes No
Days/Hours Available* Yes No
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?* Yes No
Are you available/willing to work evenings?* Yes No
Are you able to perform the essential functions of the job for which you are applying, either with /without reasonable accommodation?* Yes No
Education, Training and Experience
High School Name*
Year of graduation (or expected graduation)*
Did you graduate?* Yes No
Did you earn a Diploma? GED?*
College / University Name
Number of years completed
Did you graduate?* Yes No
Degree / diploma earned
Vocational School Name
Number of years completed
Did you graduate?* Yes No
Degree / diploma earned
List any skills and qualifications: Licenses, Skills, Training, Awards, etc.*
Do you speak, write or understand any foreign languages?* Yes No
Employment History
Provide details about the last three positions you have held. Account for any gaps in employment during that period.
Are you currently employed?* Yes No
Current Employment
Name of Employer
Phone
Street Address
Address Line 2
City
State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands
ZIP Code
Length of Employment (Include Dates)
Position & Duties
Reason for Leaving
Previous Employment
Name of Employer
Name of Employer
Phone
Street Address
Address Line 2
City
State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands
ZIP Code
Length of Employment (Include Dates)
Position & Duties
Reason for Leaving
May we contact this employer for references? Yes No
References
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.
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)
