Stone Summit Employment Application

Personal Information
Name Name First Last
Other names you have been known as (verification and reference-checking purposes)
Date Date / MM / DD YYYY
Home/Cell Phone Number Home/Cell Phone Number - ### - ### ####
Business Phone Number Business Phone Number - ### - ### ####
Email
Permanent Address Permanent Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Previous Address (if less than 5 years) Previous Address (if less than 5 years)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Do you have a valid driver's license?

Do you have a valid driver's license? Yes No
Driver's License Number
Driver's License Expiration Driver's License Expiration / MM / DD YYYY
Driver's License State
Driver's License Class
Are you at least 18 years of age?

Are you at least 18 years of age? Yes No

If you are under 18 and still in high school, you may be required to provide a work permit upon hiring.
Have you ever been convicted of a felony or a misdemeanor, including minor traffic offences that would be considered minor misdemeanor?

Have you ever been convicted of a felony or a misdemeanor, including minor traffic offences that would be considered minor misdemeanor? No Yes (give date, place, offence, and outcome)

Note: No applicant will be denied employment solely on the grounds of conviction of criminal offense. The nature, date, surrounding circumstances and relevance of the offense to the position for which you are applying will be taken into consideration. False information could be grounds for termination.
Employment Information
Position Applying For
Available Start Date Available Start Date / MM / DD YYYY
Location(s) For Which You Are Available

Location(s) For Which You Are Available Stone Summit Atlanta Stone Summit Kennesaw Stone Summit Midtown Stone Summit Atlanta Bouldering
Days & Hours Available To Work
Schedule Classification Desired

Schedule Classification Desired Part Time Full Time
Days/Hours Typically Unavailable
Are you in a position to work overtime if required?

Are you in a position to work overtime if required? Yes No
How did you hear about this position at Stone Summit (First and last name of referring member if applicable)?
Do you own a reliable source of transportation?

Do you own a reliable source of transportation? Yes No
Are you currently employed?

Are you currently employed? Yes No
If YES, may we contact your current employer?

If YES, may we contact your current employer? Yes No N/A
Have you previously been employed or contracted by Stone Summit?

Have you previously been employed or contracted by Stone Summit? Yes No
If YES, what position did you hold?
Do you speak any foreign languages?

Do you speak any foreign languages? No Yes (please list) Yes (please list)
Please list any special training, skills, or experience that is relevant to the position for which you are applying.
Please list any special trade licenses or certification which you have obtained. (CPR, American Mountain Guide Certifications, etc.)
Are you or were you previously in the military?

Are you or were you previously in the military? No Yes (please provide details) Yes (please provide details)
Please tell us about any personal accomplishments of which you are proud.
Why would you like to work at Stone Summit?
What do you hope to gain from working at Stone Summit?
Please tell us about any climbing experience you have.
Education Information
High School Name and Location

Type N/A if necessary
High School Year Graduated

Type N/A if necessary
College Name and Location

Type N/A if necessary
College Year Graduated

Type N/A if necessary
College Major

Type N/A if necessary
College Degree Earned

Type N/A if necessary
Other Education Information

Type N/A if necessary
Employment History

Beginning with your current or most recent job, list your employment experience.
Job #1
Company Name
Type of Business
Company Address Company Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Employment Start Date Employment Start Date / MM / DD YYYY
Employment End Date Employment End Date / MM / DD YYYY
Position Held
Duties
If you could have changed anything about this job, what would it have been?
Reason For Leaving
Name of Supervisor Name of Supervisor First Last
Supervisor's Position
Supervisor's Phone Number Supervisor's Phone Number - ### - ### ####
Job #2
Company Name
Type of Business
Company Address Company Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Employment Start Date Employment Start Date / MM / DD YYYY
Employment End Date Employment End Date / MM / DD YYYY
Position Held
Duties
If you could have changed anything about this job, what would it have been?
Reason For Leaving
Name of Supervisor Name of Supervisor First Last
Supervisor's Position
Supervisor's Phone Number Supervisor's Phone Number - ### - ### ####
Job #3
Company Name
Type of Business
Company Address Company Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Employment Start Date Employment Start Date / MM / DD YYYY
Employment End Date Employment End Date / MM / DD YYYY
Position Held
Duties
If you could have changed anything about this job, what would it have been?
Reason For Leaving
Name of Supervisor Name of Supervisor First Last
Supervisor's Position
Supervisor's Phone Number Supervisor's Phone Number - ### - ### ####
Business References

Please provide the names of two people with whom you have previously worked. (Not friends or relatives)
Reference #1
Name Name First Last
Company
Position
Years Known
Phone Number Phone Number - ### - ### ####
Reference #2
Name Name First Last
Company
Position
Years Known
Phone Number Phone Number - ### - ### ####
Please Provide One Emergency Contact
Name Name First Last
Relation
Home/Cell Phone Numer Home/Cell Phone Numer - ### - ### ####
Business Phone Number Business Phone Number - ### - ### ####
Email
I UNDERSTAND THAT SUBMISSION OF AN APPLICATION DOES NOT GUARANTEE EMPLOYMENT. I UNDERSTAND THAT NONE OF THE DOCUMENTS, POLICIES, PROCEDURES, ACTIONS, AND STATEMENTS OF STONE SUMMIT OR ITS REPRESENTATIVES USED DURING THE EMPLOYMENT PROCESS IS DEEMED A CONTRACT OF EMPLOYMENT REAL OR IMPLIED. I UNDERSTAND THAT NO REPRESENTATIVE OF STONE SUMMIT EXCEPT THE CEO HAS THE AUTHORITY TO ENTER INTO ANY AGREEMENT GURANTEEING ANY CONDITIONS OF EMPLOYMENT OR ANY AGREEMENT CONTRARY TO THE FOREGOING STATEMENTS AND THAT ANY SUCH AGREEMENTS MUST BE MADE IN WRITING AND SIGNED BY THE CEO OF STONE SUMMIT.

I understand that in connection with my application for employment (including contracts of service), Stone Summit Climbing and Fitness Center (StoneSummit) will use an outside agency to research and verify information I have provided. I hereby authorizeStone Summit and/or entity directed by Stone Summit prior to or at any time after my employment commences, to obtain a consumer report for employment purposes. I understand this consumer report may include inquiries regarding my work history, court records, including criminal convictions record, as permitted by law, driving history, verification of Social Security number and references obtained from professional and personal associates.

If employed by Stone Summit and in consideration of my employment, I agree to abide by the written and unwritten rules and regulations of Stone Summit ,and agree that my employment and compensation can be terminated at will, with or without cause, with or without notice, at any time either at my option or at the option of Stone Summit.

I authorize prior employers, references and others identified in this application as sources of information regarding my character, qualifications, work history and background to provide information without limitations and release all parties and persons from any and all liability for any damages that may result from furnishing such information to Stone Summit ,as well as from the use or disclosure of such information by Stone Summit or any of its agents, associates or representatives. I also understand that all offers of employment are conditioned of Stone Summit's receipt of satisfactory responses to reference request.

I hereby certify that all the forgoing information I have supplied in this application is correct and complete. Furthermore,I understand that any representation, falsification or material omission of information in this application may result in my failure to receive an offer or if I have been hired, my immediate dismissal from employment.

I understand that all offers of employment are conditioned on the provision of satisfactory proof of my identity and legal authority to work in the U. S. Offers of employment are also conditioned on the satisfactory completion of test for drug and /or alcohol at Stone Summit's selected facility at Stone Summit's expense, and I understand that Stone Summit may use any information obtained from such tests to the extent permitted by the state and federal law.

I understand rock climbing, whether indoors or outside, is a technical sport involving inherent and other risks, hazards, and danger that can lead to injury, paralysis, or death. CLIMBING IS DANGEROUS! In choosing to engage in climbing activities, employees understand that they assume responsibility for their own actions and/or any losses or injuries they suffer, resulting from the inherent and other risks of these activities.

Stone Summit is committed to a policy of equal employment opportunity for applicants and associates. Employment decisions shall comply with all applicable laws prohibiting discrimination in employment, including Title VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act of 1968, the Americans with Disabilities Act 1990, the immigration and Nationality Act, and any applicable state laws.

A photocopy hereof, or a record of this Employment Application sent and received by facsimile, email or other electronic transmission, or a record of this Employment Application stored in an electronic or other medium, shall be enforceable and shall have full legal effect as an original.

Please sign below to acknowledge agreement.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY

Stone Summit Employment Application

Stone Summit Employment Application

Personal Information

Employment Information

Education Information

Employment History

Business References

Please Provide One Emergency Contact