Name

Address

City

State/Province

Zip

Phone

Email

Availability Start Date:

Availability Finish Date:

Department(s) you are applying for:

Dining Room Kitchen Housekeeping Front Desk Other

Position:

Are you 18 years or older? Yes No

Have you ever been convicted of a criminal offense? Yes No

Are you willing to comply with our alcohol and drug policy? Yes No

Do you need living accommodations?Yes No

Please list below your previous three employers. Please explain all unaccounted for gaps in time.

Employer 1

Employer Name:

Supervisor:

Employer Phone:

Salary:

Dates of Employment

Reason for leaving:

Employer 2

Employer Name:

Supervisor:

Employer Phone:

Salary:

Dates of Employment

Reason for leaving:

Employer 3

Employer Name:

Supervisor:

Employer Phone:

Salary:

Dates of Employment

Reason for leaving:

Please comment on any time gaps in employment and/or ask any questions about the position(s) in which you are applying:

I authorize this company to make inquiries of any of my former employers or references as to my experience, work habits or reason for leaving. I agree to abide by the rules of this company. I certify that all statements are true to the best of my knowledge and understanding. The making of false statements will be sufficient cause for immediate dismissal.

Initial here:

The Asticou Inn is an equal opportunity employer dedicated to a policy of compliance with all federal, state and local laws regarding nondiscrimination in employment. No question on theis application is intended to secure information to be used for unlawful purposes. Applicants are considered for all positions without regard to race, color religion, sex, ancestry or national origin, age or veteran status. In addition, this company does not discriminate on the basis of physical or mental disabilities where the essential functions of the job, as reasonably accommodated, do not require such distinction. No question of this application is intended to secure information to be used for unlawful purposes. Consent with the provisions of the Americans with Disability Act (ADA) and the Maine Human Rights Act (MHRA), applicants may request accommodations needed to participate in the application process.