PERSONAL INFORMATION:
Full Name:
How did you hear of us?
PRESENT ADDRESS:
Street:
City:
State:
Zip:
Phone Number:
Cell Phone:
Email Address: (required)
Position Applied For:
If under 21, please list date of birth:
Which Location?
--- Select a Location ---
MD - Germantown NC - Harrisburg PA - Willow Grove PR - Guaynabo VA - Blacksburg VA - Richmond - West End VA - Lynchburg VA - Mechanicsville VA - Midlothian Romp n' Roll China Romp n' Roll South Korea
Do you have the legal right to work and remain in the United States?
Yes
No
Date You Can Start:
Wage Desired:
Type of Employment Desired:
Full Time
Part Time
Temporary
Seasonal
Have you ever been
employed with us before?
Yes
No
If yes, give date:
AVAILABILITY
Sunday
From
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
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4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
To
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
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3:30pm
4:00pm
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5:00pm
5:30pm
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6:30pm
7:00pm
7:30pm
8:00pm
Monday
From
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
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3:30pm
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4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
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7:30pm
8:00pm
To
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
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11:30am
12:00pm
12:30pm
1:00pm
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3:30pm
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4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
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7:30pm
8:00pm
Tuesday
From
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
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4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
To
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
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4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
Wednesday
From
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
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12:30pm
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4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
To
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
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3:30pm
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4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
Thursday
From
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
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3:30pm
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4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
To
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
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8:00pm
Friday
From
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
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3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
To
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
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3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
Saturday
From
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
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4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
To
Not Available
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
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3:30pm
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6:30pm
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7:30pm
8:00pm
EMPLOYMENT HISTORY
List employment, starting with your most recent position. Account for any time during this period you were unemployed by stating the nature of your activities.
May we contact your present employer?
Yes
No
Company Name #1
Employed From / To:
Address:
Phone:
Supervisor:
Title:
Job Title & Duties:
Starting Salary & Title:
Ending Salary & Title:
Reason For Leaving:
Company Name #2
Employed From / To:
Address:
Phone:
Supervisor:
Title:
Job Title & Duties:
Starting Salary & Title:
Ending Salary & Title:
Reason For Leaving:
Company Name #3
Employed From / To:
Address:
Phone:
Supervisor:
Title:
Job Title & Duties:
Starting Salary & Title:
Ending Salary & Title:
Reason For Leaving:
EDUCATION:
High School
Name/Location:
Years Attended:
Did You Graduate?
Yes
No
College
Name/Location:
Years Attended:
Did You Graduate?
Yes
No
Other
Name/Location:
Years Attended:
Did You Graduate?
Yes
No
Have you ever served in the military?
Yes
No
If yes, please list dates served, branch, technical specialization, and rank attained:
MISCELLANEOUS:
How would you describe yourself:
Very Outgoing
Usually Outgoing
Shy
Reserved
Other
If other:
Please list special skills, training, education or experiences that directly relate to the job you are applying for:
What is important to you in choosing a job?
Have you ever been discharged from a job?
Yes
No If yes, please explain:
Why do you want to work at Romp n' Roll?
What contribution do you feel that you can make to our company?
Tell us a little bit about your favorite job:
Tell us something about a job situation that you disliked:
Have you ever been convicted of a crime?
Yes
No If yes, please explain:
REFERENCES:
List two personal references (other than relatives) List Name, Address, Phone Number, & number of years known.
Reference 1
Name:
Address:
Phone:
Years Known:
Reference 2
Name:
Address:
Phone:
Years Known:
LEGAL INFORMATION
I hereby affirm that the information given by me on the application for employment is complete and accurate. I understand that any falsification or omission either on this application, or otherwise providing false information to the Company will be immediate grounds for dismissal, no matter when the falsification or omission is discovered. I authorize a thorough investigation to be made in connection with this application concerning my credit worthiness, credit standing, character, general regulation, personal characteristics, employment, education, and criminal record, whichever may be applicable for employment purposes. I understand this investigation may include personal interviews with third parties such as business associates. I further understand I have the right to make a written request within a reasonable period of time for complete and accurate disclosure of the nature and scope of the investigation.
If I am hired, I agree that my employment and compensation can be terminated with or without cause, and without notice at any time, at the option of Romp n' Roll or myself. I understand that, unless modified in written agreement signed by both me and the President of Romp n' Roll, no representative of Romp n' Roll has the authority to make any agreement for employment for a specified time or to make any other agreement contrary to the foregoing.
Date:
Signature: