1-501-268-8080
954 Skyline Drive-Searcy, AR 72143

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HealthCorp Employment Application
Searcy Athletic Club – WellSpring Spa

Please fill out the following:
Applicant Data





If you are under 18 and we require a work permit, can you furnish one? Yes No
If no, please explain:
Have you ever worked for this company? Yes No
Are you a citizen of the United States? Yes No
Have you ever pleaded “guilty,” “no contest,” or been convicted of a crime? Yes No
(By answering “yes” to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be considered.)
If yes, give dates and details:
How were you referred to us:
Type of employment desired: Full-Time Part-Time

Shifts available to work (check all that apply):
Floor:
Monday-Friday (Open- 4:30 am – 12:00 pm)
Monday-Friday (Day- 12:00 pm – 5:00 pm)
Monday-Thursday (Close- 5:00 pm – 10:30 pm)
Friday (Close- 5:00 pm – 8:00 pm)
Saturday (Open- 7:30 am – 1:00 pm)
Saturday (Close- 1:00 pm – 6:00 pm)
Sunday (11:30 am – 6:00 pm)

Desk:
Monday-Friday (Open- 4:30 am – 12:00 pm)
Monday-Friday (Day- 12:00 pm – 5:00 pm)
Monday-Thursday (Close- 5:00 pm – 10:30 pm)
Friday (Close- 5:00 pm – 8:00 pm)
Saturday (Open- 7:30 am – 1:00 pm)
Saturday (Close- 1:00 pm – 6:00 pm)
Sunday (11:30 am – 6:00 pm)

Childcare:
Monday-Friday (8:00 am – 1:00 pm)
Monday-Friday (3:30 pm – 8:00 pm)
Saturday (8:00 am – 12:00 pm)
Sunday (1:00 pm – 5:00 pm)

Other:


Previous Employment
Begin with most recent position.

Dates of Employment: From Pick a date To Pick a date
Firm:Position(s) Held:
Address:Phone:
Supervisor:Title:
Responsibilities:
Starting Salary:Ending Salary:
Reason for Leaving:
May we contact this employer for a reference? YesNo

Dates of Employment: From Pick a date To Pick a date
Firm:Position(s) Held:
Address:Phone:
Supervisor:Title:
Responsibilities:
Starting Salary:Ending Salary:
Reason for Leaving:
May we contact this employer for a reference? YesNo

Dates of Employment: From Pick a date To Pick a date
Firm:Position(s) Held:
Address:Phone:
Supervisor:Title:
Responsibilities:
Starting Salary:Ending Salary:
Reason for Leaving:
May we contact this employer for a reference? YesNo

Other References:
Name:Title:Phone:
Name:Title:Phone:
Name:Title:Phone:


Summarize your special skills or qualifications:



I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

In the event that I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

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