Employment Application

Full NameStreet AddressCity, State, Zip

Email AddressPhone NumberReferred by (how did you hear about this job)

Positions(s) you are applying for:

Chase CrewPilotSales & Administration

Please answer the following:

1. Have you applied or worked here before? If so, when?

2. Have you ever worked for a balloon company or have any balloon experience?

3. Do, or have, any of your friends or relatives worked here? If so, who?

4. If hired, would you have reliable transportation to and from work?

5. Are you licensed / certified for the job applied for?

6. Are you able to perform essential functions of the job for which you are applying? If no, describe the functions that cannot be performed.

**We may refuse to hire relatives of present employees if doing so could result in actual or potential problems in supervision, security, safety, or morale, or if doing so could create conflicts of interest.

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Recent Work Experience

Employer 1

Name

Supervisor

Phone Number

Dates worked

I am currently employed hereYou may contact this employer for a reference

Employer 2

Name

Supervisor

Phone Number

Dates worked

I am currently employed hereYou may contact this employer for a reference

Employer 3

Name

Supervisor

Phone Number

Dates worked

I am currently employed hereYou may contact this employer for a reference

Personal References

Name

Phone Number

Name

Phone Number

Name

Phone Number

Acknowledgement

Please read carefully, accept each paragraph by checking the corresponding box and sign below

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.I hereby authorize to thoroughly investigate my references, work record, education and other matters related to my suitability for employment (excluding criminal background information) unless otherwise specified above. I further authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

The Company will consider qualified applicants, including those with criminal histories, in a manner consistent with state and local "Fair Chance" laws.

Signature (please type your name in the box below to sign)

Date

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