Employment Application

NORTH PEAK, INC EMPLOYMENT APPLICATION

It is the policy of North Peak, Inc to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

Applicant Full Name*

Home Address*

City*

State*

Zip*

Email Address*

Number of Years at this address

Daytime Phone

Evening Phone

Mobile Phone

Emergency Contact

Who should be contacted if you are involved in an emergency?

Contact Name

Relationship to you

Address

City

State

Zip

Daytime Phone

Evening Phone

Job Applied For*

Full or Part Time?* Full Time Part Time

Are You at least 18 years old?* Yes No

Date of Birth

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.

Employer Name

Supervisor Name

Address

Employer City/State/Zip

Job Duties

Reason for leaving

Dates of Employment (Month/Year)

Employer Name

Supervisor Name

Address

Employer City/State/Zip

Job Duties

Reason for leaving

Dates of Employment (Month/Year)

Employer Name

Supervisor Name

Address

Employer City/State/Zip

Job Duties

Reason for leaving

Dates of Employment (Month/Year)

Applicant's Education and Training

College/University Name and Address

Did you receive a degree? Yes No

If yes, degree(s) received:

High School/GED Name and Address

Did you receive a degree? Yes No

Other Training (graduate, technical, vocational):

Please indicate any current professional licenses or certifications that you hold:

Awards, Honors, Special Achievements:

Military Service: Yes No

Military Branch

Specialized Training:

References

List any two non-relatives who would be willing to provide a reference for you.

Name

Address

City/State/Zip

Telephone

Relationship

Name

Address

City/State/Zip

Telephone

Relationship

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

Requested starting pay:

Are you willing to submit to drug testing?* Yes No

Are you willing to agree to background check?* Yes No

CERTIFICATION

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize North Peak, Inc to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of North Peak, Inc, except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

Signature*

Enter the text you see in the box.