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GRETNA/ALTAVISTA/CHATHAM

200 MCBRIDE LN
GRETNA VA 24557
T (434) 656-9000
F (434) 656-9001


Employment Application
Conditions of employment are stated at the end of this form. Please read carefully before you sign this application.
(Application must be complete in full, even if attaching a resume)

POSITION APPLYING FOR ____________________
DATE OF APPLICATION ____________________


PERSONAL
FULL
NAME
PLEASE PRINT USING A BALLPOINT PEN.
SOCIAL SECURITY NUMBER
PRESENT
ADDRESS
CITY STATE/ZIP HOME PHONE
PREVIOUS
ADDRESS
CITY STATE/ZIP MOBILE PHONE
IF NO PHONE, HOW MAY WE
CONTACT YOU?
ARE ANY OF YOUR RELATIVES PRESENTLY EMPLOYED WITH THE HAMPTON INN COMPANY OR ITS DIVISIONS? _____YES _____NO
IF YES, NAME OF RELATIVE:
HAVE YOU EVER WORKED FOR THE HAMPTON INN COMPANY OR ITS DIVISION BEFORE? _____YES _____NO
IF YES, WHERE? (APPROXIMATE DATE: MONTH/YEAR.)
HAVE YOU EVER APPLIED FOR THE HAMPTON INN COMPANY OR ITS DIVISIONS BEFORE? _____YES _____NO
IF YES, WHEN/WHERE? (APPROXIMATE DATE: MONTH/YEAR)
IF NO PHONE, HOW MAY WE
CONTACT YOU?

GENERAL INFORMATION
IF YOU ARE UNDER THE AGE OF
18, PLEASE STATE YOUR AGE:
IF UNDER THE AGE OF 18, CAN YOU
PROVIDE WORKING PAPERS?
_____YES _____NO
ARE YOU ABLE TO PERFORM THE ESSENTIAL REQUIREMENTS OF THE JOB? _____YES _____NO
IN NO, ARE THERE ANY REASONABLE ACCOMODATIONS THAT CAN BE MADE TO ALLOW YOU TO PERFORM THE ESSENTIAL
FUNCTIONS OF THE JOB?
HAVE YOU EVER BEE CONVICTED OF A CRIME OR VIOLATION OTHER THAN A MINOR TRAFFIC INFRACTION? _____YES _____NO
(A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT, FACTORS SUCH AS JOB RELATIONS, AGE AND TIME OF THE
OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION AND REHABILITATION WILL BE TAKEN INTO ACCOUNT.)
IF YES, PLEASE EXPLAIN:

HAVE YOU EVER BEEN DISCHARGED FROM ANY EMPLOYMENT OR ASKED TO RESIGN? _____YES _____NO
IF YES, PLEASE EXPLAIN:
PLEASE CHECK SCHEDULE AVAILABILITY:
_____ I AM AVAILABLE AND DESIRE TO WORK FULL-TIME (35 HOURS) AND DO NOT HAVE ANY RESTRICTIONS ON MY HOURS OF DAYS.
(COMPLETE SECTION B)
_____ I AM AVAILABLE AND DESIRE TO WORK PART-TIME. (IF LESS THAN 34 HOURS A WEEK, PLEASE COMPLETE SECTIONS A & B)

AVAILABILITY
A. I AM ONLY AVAIABLE FOR PART-TIME BECAUSE:
_____STUDENT _____OTHER JOB _____OTHER (EXPLAIN) ___________________________________________________________________
B. HOURS
AVAILABLE
FROM
TO


NOTE: WORK SCHEDULES ARE BASED UPON THE NEEDS OF THE BUSINESS AND MY BE SUBJ ECT
TO CHANGE ON A WEEKLY BASIS.

EMPLOYMENT HISTORY




BEGIN WITH YOU MOST RECENT EMPLOYER AND CONTINUE WITH ALL PAST EMPLOYMENT.
(ATTACH ADDITIONAL SHEET IF NECESSARY)
EMPLOYER FROM
MO. YR.

STARTING
SALARY
$
JOB TITLE
DESCRIBE YOU JOB
DUTIES
ENDING
SALARY
$
ADDRESS
CITY, STATE, ZIP
PHONE NO.
EXPLAIN ANY PERIOD
BETWEEN JOBS
TYPE OF BUSINESS
REASON FOR LEAVING
(PLEASE EXPLAIN)
NAME OF IMMEDIATE
SUPERVISOR
MAY WE CONTACT EMPLOYER?
_____ YES _____ NO
EMPLOYER
ADDRESS
CITY, STATE, ZIP
PHONE NO.
EXPLAIN ANY PERIOD
BETWEEN JOBS
FROM
MO. YR.

STARTING
SALARY
$
ENDING
SALARY
$
TYPE OF BUSINESS
DESCRIBE YOU JOB
DUTIES
JOB TITLE REASON FOR LEAVING
(PLEASE EXPLAIN)
NAME OF IMMEDIATE
SUPERVISOR
MAY WE CONTACT EMPLOYER?
_____ YES _____ NO
EMPLOYER
ADDRESS
CITY, STATE, ZIP
PHONE NO.
EXPLAIN ANY PERIOD
BETWEEN JOBS
FROM
MO. YR.

STARTING
SALARY
$
ENDING
SALARY
$
TYPE OF BUSINESS
JOB TITLE
DESCRIBE YOU JOB
DUTIES
REASON FOR LEAVING
(PLEASE EXPLAIN)
NAME OF IMMEDIATE
SUPERVISOR
MAY WE CONTACT EMPLOYER?
_____ YES _____ NO
WAGE EXPECTED? DATE AVAILABLE FOR WORK?



MONDAY

_____ AM
_____ PM



TUESDAY




WEDNESDAY




THURSDAY




FRIDAY




SATURDAY




SUNDAY

_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM
_____ AM
_____ PM

EMPLOYMENT HISTORY




EDUCATION
TYPE OF SCHOOL
HIGH SCHOOL
COLLEGE
GRADUATE SCHOOL
BUSINESS/TRADE/OTHER

NAME AND ADDRESS OF SCHOOL




MAJOR
SUBJECT

\
CIRCLE LAST
YEAR
ATTENDED
























=

\


\


\


\

GRADUATED

\

DEGREE
=
=
=
=
=
=
=
=

ADDITIONAL EXPERIENCE OR QUALIFICATIONS


LIST ANY EXPERIENCE, SKILLS OR OTHER QUALIFICATIONS INCLUDING HOBBIES, WHICH YOU BELIEVE SHOULD BE
CONSIDERED IN EVALUATING YOUR QUALIFICATIONS FOR EMPLOYEMENT.
PLEASE INDICATE ANY PRIOR MILITARY SERVICE WHICH YOU WOULD LIKE CONSIDERED IN CONNECTION WITH YOU R ALPPLICATION
FOR EMPLOYMENT.


ADDITIONAL EXPERIENCE OR QUALIFICATIONS
CONSISTANT ATTENDANCE AND PUNCTUALITY ARE ESSENTIAL REQUIRMENTS OF EVERY JOB WITH THIS COMPANY.

PERSONAL OR BUSINESS REFERENCES
NAME OCCUPATION BUSINESS PHONE
HOME ADDRESS/HOME PHONE TITLE/ RELATIONSHIP
CITY/STATE/ZIP YEARS KNOWN
NAME OCCUPATION BUSINESS PHONE
HOME ADDRESS/HOME PHONE TITLE/ RELATIONSHIP
CITY/STATE/ZIP YEARS KNOWN
NAME OCCUPATION BUSINESS PHONE
HOME ADDRESS/HOME PHONE TITLE/ RELATIONSHIP
CITY/STATE/ZIP YEARS KNOWN

NOTIFICATION AND AGREEMENT





PLEASE READ CAREFULLY BEFORE SIGNING.


I CERTIFY THAT ALL ANSWERS BY ME ARE TRUE ACCURATE AND COMPLETE, I UNDERSTAND THAT THE FALSIFICATION,
MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY ACCOMPANYING OR REQUIRED DOCUMENTS)
WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN
OR HOW DISCOVERED.

ONLY U.S. CITIZENS OR ALIENS WHO HAVE A LEGAL RIGHT TO WORK IN THE U.S. ARE ELIGIBLE FOR EMPLOYMENT. UPON
EMPLOYMENT, YOU MUST PROVIDE GENUINE DOCUMENTATION ESTABLISHING YOUR IDENTITY AND ELIGIBILITY TO BE
LEGALLY EMPLOYED IN THE UNITED STATES.

QUESTIONS REGARDING THE FOLLOWING STATEMENT SHOULD BE DIRECTED TO ANY EMPLOYMENT INTERWIEWER BEFORE
SIGNING. THE APPLICATION WILL BE GIVEN EVERY CONSIDERATION, BUT ITS RECIEPT DOES NOT IMPLY THAT THE APPLICANT
WILL BE EMPLOYED. PLEASE INITIAL AFTER EACH OF THE FOLLOWING STATEMENTS.

IT IS THE POLICY OF THE COMPANY TO AFFORD EQUAL OPPORTUNITY TO ALL EMPLOYEES AND APPLICANTS FOR
EMPLOYMENT WITHOUT REGARD TO AGE, RACE, RELIGION, COLOR, SEX, SEXUAL PREFERENCE, NATIONAL ORIGIN,
MARITAL STATUS, AND TO AFFORD EQUAL OPPORTUNITIES TO DISABLED VETERANS, VETERANS OF THE VIETNAM ERA
AND INDIVIDUALS WITH A DISABILITY, AND OTHER CHARACTERICS PROTECTED BY FEDERAL, STATE OR LOCAL LAW.
__________ (INITIAL)

I AUTHORIZE THE INVESTIGATION OF ALL STATEMENTS AND INFORMATION CONTAINED IN THIS APPLICATION. I RELEASE
FROM ALL LIABILITY ANYONE SUPPLYING SUCH INFORMATION AND I ALSO RELEASE THE EMPLOYER FROM ALL
LIABILITY THAT MIGHT RESULT FROM MAKING AND INVESTIGATION. __________ (INITIALS)

IF HIRED, I AGREE TO ABIDE BY ALL OF COMPANY RULES AND REGULATION, AND UNDSTAND THAT IF EMPLOYED MY
EMPLOYMENT MAY BE TERMINATED WITH OR WITH OUT CAUSE AND WITH OR WITHOUT NOTICE AT ANY TIME AT THE
OPTION OF EITHER THE COMPANY OR ME. I FURTHER UNDERSTAND THAT NO REPRESENTATION, WHETHER ORAL OR
WRITTEN BY ANY REPRESENTATIVE OR AGENT OF THE COMPANY, AT ANY TIME, CAN CONSTITUTE A CONTRACT OF
EMPLOYMENT. I UNDERSTAND THAT THE COMPANY AND ALL PLAN ADMINISTRATORS SHALL HAVE THE MAXIMUM
BENEFITS OR OTHER TERMS OR CONDITIONS OF EMPLOYMENT. NO REPRESENTITIVE OR AGENT OF THE COMPANY HAS
THE AUTHORITY TO INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME OR TO MAKE ANY
CHANGE IN ANY POLICY, PROCEDURE, BENEFIT OR OTHER TERM OR CONDITION OF EMPLOYMENT OTHER THAN IN A
DOCUMENT SIGNED BY THE PRESIDENT OR EXECUTIVE VICE PRESIDENT, OR TO MAKE ANY AGREEMENT CONTRARY
TO THE FOREGOING. __________ (INITIAL)

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE STATEMENTS AND HEREBY GRANT PERMISSION
TO CONFIRM THE INFORMATION SUPPLIED ON THIS APPLICATION BY ME. __________ (INITIAL)

IF SELECTED FOR EMPLOYMENT, I UNDERSTAND THAT A $22.00 BACKGROUND FEE WILL BE DEDUCTED FROM MY FIRST
CHECK AND THAT THIS FEE WILL BE RETURNED TO ME ONCE I HAVE COMPLETED 90 DAYS OF EMPLOYMENT.


APPLICANT SIGNATURE _____________________________________________ DATE ___________________________________________

NOTIFICATION AND RELEASE SALES REPRESENTATIVE ______________________________

COMPANY NAME __________________________________________________ ACCESS ID ______________________


BEE CHECK ID ________________________________ CAC CODE ___________________________________________

THE INFORMATION CONTAINED IN MY APPLICATION FOR EMPLOYMENT WITH
________________________________________________(COMPANY NAME) IS TRUE TO THE BEST OF MY
KNOWLEDGE AND BELIEF. I UNDERSTAND THAT ANY MISREPRESENTATION OR FALSE STATEMENT
MADE BY ME IN CONNECTION WITH THE APPLICATION OR ANY RELATED DOCUMENTS WICHI IS
DEEMED MATERIAL BY THE COMPANY SHALL RESULT IN THE COMPANY NOT EMPLOYING ME
OR, IF EMPLOYED, TEMINATING MY EMPLOYMENT. I UNDERSTAND AND AGREE THAT ALL
INFORMATION FURNISHED IN MY APPLICATION AND ALL ATTACHMENTS MAY BE VERIFIED BY THE
COMPANY OR ITS AUTHORIZED REPRESENTATIVE. I HEREBY AUTHORIZE ALL INDIVIDUALS AND
ORGANIZATIONS NAMED OR REFERRED TO IN MY APPLICATION OR REFERRED TO IN MY
APPLICATIONAND ANY LAW ENFORCEMENT ORGANIZATION TO GIVE THE COMPANY ALL
INFORMATION RELATIVE TO SUCH VERIFICATION AND HEREBY RELEASE SUCH INDIVIDUALS,
ORGANIZATIONS AND THE COMPANY FROM ANY AND ALL LIABILITY FOR ANY CLAIM OR DAMAGE
RESULTING THEREFROM. I HEREBY ACKNOWLEDGE THAT I HAVE BEEN INFORMED BY THE COMPANY
THAT THE COMPANY MAY SEEK TO OBTAIN A CONSUMER REPORT AND/OR INVESTIGATIVE REPORT
THAT WILL INCLUDE PERSONAL INFORMATION REGARDING ME, INCLUDING BUT NOT LIMITED TO
EDUCATIONAL HISTORY, WORK REFERENCES, DRIVING RECORD, DRUG TESTING AND CRIMINAL
CONVICTIONS OR ARREST RECORDS IF ALLOWED, IN ORDER TO ASSIST THE COMPANY IN MAKING
CERTAIN EMPLOYMENT DECISIONS. I FURTHER ACKNOWLEDGE NOTIFICATIONS BY THE COMPANY
THAT REPORTS MAY BE PROVIDED TO THE COMPANY BY OTHER FIRMS SUBCONTRACTED FOR THAT
PURPOSE. I, MY HEIRSM ASSIGNS AND LEGAL REPRESENTATIVES, HEREBY RELEASE AND FULLY
DISCHARGE THE COMPANY, ITS PARENT AND AFFILIATED COMPANIES AND THE RESPECTIVE
OFFICERS, DIRECTORS, SHAREHOLDRS, EMPLOYEES, AGENTS OF EACH, INCLUDING
SUBCONTRACTORS, FROM ANY AND ALL CLAIMS, MONETARY OR OTHERWISE, THAT I MAY HAVE
AGAINST THE COMPANY, ITS PARENT AFFILIATES OR SUBCONTRACTORS, ARRISING OUT OF THE
MAKING, OR USE OF, EITHER A CONSUMER REPORT AND/OR INVESTIGATIVE REPORT, INCLUDING
ANY ERRORS OR OMISSIONS CONTAINTED OR OMITTED FROM SUCH REPORTS OR INVESTIGATIONS.
THE COMPANY AGREES TO INFORM YOU IF AN EMPLOYMENT DECISION HAS BEEN INFLUENCED
BY INFORMATIVE CONTAINED IN A CONSUMER REPORT, MADE AT OUR REQUEST BY CASTLE BRANCH
INC. YOU MAY OBTAIN A FREE COPY OF THE REPORT WITHIN 60 DAYS BY CALLING CASTLE BRANCH
INC. COLLECT AT (910) 815-3880 OR TOLL FREE AT (888) 520-0520. THE COMPANY WILL MAKE
AVAILABLE TO YOU A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT.


PLEASE PRINT

NAME __________________________________________ DATE OF BIRTH _____________________________________

SOCIAL SECURITY # __________ ______ ___________ DRIVERS LICENSE # ______________________ STATE _____

CURRENT AND PREVIOUS ADDRESSES FOR PAST SEVEN YEARS

STREET _____________________________________________ CITY, STATE, ZIP _________________________________

FROM (MO./YR.) __________________________________ TO (MO./YR.) ________________________________________

STREET _____________________________________________ CITY, STATE, ZIP _________________________________

FROM (MO./YR.) __________________________________ TO (MO./YR.) ________________________________________

STREET _____________________________________________ CITY, STATE, ZIP _________________________________

FROM (MO./YR.) __________________________________ TO (MO./YR.) ________________________________________