PERSONAL INFORMATION

Name*

Email*

Phone Number*

Present Address:

Street Address*

City*

State*
—Please choose an option—ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip*

In order to permit a check of your work and education records, are there any other names that you have previously used?*
YesNo

If yes, identify name(s) and relevant date(s):

GENERAL EMPLOYMENT QUESTIONS

How did you learn about us?*
AdvertisementFriendWalk-InWeb PageEmployment AgencyRelativeAn Island EmployeeFacebook/Social MediaOther

Position applied for:*

Can Start: (Format: MM-DD-YYYY)*

Are you employed now?*
YesNo

If so, may we contact your present employer?
YesNo

If no, then please explain reason:

Are you currently able to be employed lawfully in this country? (Note that proof of citizenship or immigration status will be required upon employment.)*
YesNo

Are you currently on "lay-off" status and subject to recall?
YesNo

If yes, please explain:

Can you travel if the job requires it?*
YesNo

PERSONAL REFERENCES

(Give the names of three persons not related to you, whom you have known at least one year. Do not include any prior employer.)

Personal Reference (1):

Name*

Address*

Relationship*

Years Acquainted*

Area Code/Phone Number*

Personal Reference (2):

Name*

Address*

Relationship*

Years Acquainted*

Area Code/Phone Number*

Personal Reference (3):

Name*

Address*

Relationship*

Years Acquainted*

Area Code/Phone Number*

Have you ever plead guilty to or no contest to a crime or been convicted of a crime that has not been expunged?* Note: A conviction does not constitute an automatic bar to employment - the type of conviction, when it occurred, and other factors will be considered.
YesNo

If yes, please explain:

If hired, would you be able to perform all functions and all necessary job assignments of the particular job for which you are applying?*
YesNo

If no, please explain:

RESUME

Please upload your resume using the button below.

CERTIFICATION

I hereby authorize the release of any employment data relevant to my employment with An Island, LLC (Company) for the purpose of an employment investigation. I authorize a thorough investigation of my past employment, activities, and background and agree to cooperate in such investigation, and release from all liability or responsibility all persons and corporations requesting or supplying such information. This investigation may also include a determination regarding whether I have a criminal record.

I agree to submit to any lawful drug, alcohol, or other testing that may be required as a condition of employment or continued employment and understand that refusal to promptly submit and cooperate with such testing prior to or during the course of my employment will result in disqualification from consideration for employment or, if hired, termination.

I fully understand that if employed, any misrepresentation or omission on this Application or any other Company record will result in dismissal, regardless of the date of discovery. I acknowledge that employment is also subject to a satisfactory review of my references.

Neither this Application nor any statement made to me during the hiring process or thereafter shall be considered a contract of employment of any kind. Where such a contract is intended, I understand that it will be separately entered into and signed by the Founder/CEO of the Company. Absent such a contract, I understand that, if hired, my employment will be terminable-at-will, with or without a cause or notice, that I am not being employed for any specified or definite period of time, and that this application is not and is not intended to be a contract, offer, statement or confirmation of or for continued employment. I understand that any employee handbook or manual does not represent an employment contract if I am hired. I understand that the Company may alter, modify, amend, or terminate any of its policies and benefits, both as to active and retired employees.

I accept the above certification statement.

Date (Format: MM-DD-YYYY)*

E-Signature*

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