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Applicant Information Release

I hereby authorize any person, educational institution, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will hold Activ8, LLC, any former employers, educational institutions, and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information incident to the employment process.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Additional Information

Applicant Information


How did you hear about the job?

Position Applied For:

Available Start Date:

Desired Salary
Please check all shifts that you will be available to work: *
Mornings:
Afternoons:
Evenings:
Weekends:
Are you a citizen of the United States?*
Yes
No
If no, are you authorized to work in the U.S.?*
Yes
No
Have you ever worked for this company?*
Yes
No

If so, when?
Have you ever had your professional license disciplined?*
Yes
No

If yes, explain
Have you ever been convicted of a crime?*
Yes
No

If yes, explain

Conviction of a crime will not necessarily be a bar to employment. Factors such as age at the time of the offense, type of offense, remoteness of the offense in time, and rehabilitation will be taken into account in determining effect on suitability for employment. 

E​DUCATION 


High School

Address

From

To
Did you graduate?*
Yes
No

Degree

College

Address

From

To
Did you graduate?*
Yes
No

Degree

Other

Address

From

To
Did you graduate?*
Yes
No

Degree

Other

Address

From

To
Did you graduate?*
Yes
No

Degree

Dates of education are used for the purpose of facilitating reference-checking only. 

C​ERTIFICATIONS​, ​INTERNSHIPS​, ​AND​ ​CONTINUING​ ​EDUCATION 


Please list additional professional certifications (ATC, CPT, CSCS, etc):

Please list certifications achieved through continuing education (FMS lv1,2, SFMA, RKC, Strong First, etc):

Please list any internships with dates:

Please list your recent continuing education attended:

REFERENCES

Please list at least three professional references. 


Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

P​REVIOUS​ E​MPLOYMENT 


Company

Phone

Address

Supervisor

Job Title

Responsibilities

From

To

Reason for Leaving
May we contact your previous supervisor for a reference?*
Yes
No

Company

Phone

Address

Supervisor

Job Title

Responsibilities

From

To

Reason for Leaving
May we contact your previous supervisor for a reference?*
Yes
No

Company

Phone

Address

Supervisor

Job Title

Responsibilities

From

To

Reason for Leaving
May we contact your previous supervisor for a reference?*
Yes
No

M​ILITARY​ S​ERVICE


Branch

From

To

Rank at Discharge

D​ISCLAIMER​ ​AND​ S​IGNATURE

I certify that the statements I have made are true and correct to the best of my knowledge. I understand that the submission of any false information or the omission of any requested information in connection with my application for employment, whether on this document or not, may be cause for failure to hire or for immediate discharge should I be employed by Activ8, LLC."

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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