Empire Roller Rink
                       Application for Employment                      1-30-06
Date of Application:_____________________________

Position(s) applied
for:_________________________________________________________________________

How did you learn about
us?____________________________________________________________________

Last
Name:_____________________________________First:__________________________MI:____________

Address:____________________________________________________________________________________

City__________________________________State___________________Zipcode_________________________

Phone
(Home)________________________Cell:________________________SSN________________________

Date of Birth:   
(mo)_______________(day)_________________(year)__________________________________

If you are under 18yrs of age, can you provide required proof of your eligibility to work?
Yes_______No______

Are you currently employed?   Yes____ No_____. May we contact your present employer?
Yes______No_____

Are you prevented from lawfully becoming employed in this country because of VISA or Immigration
status?
Yes_____No______.  (Proof of citizenship or immigration status will be required upon employment).

Are you available to work:  Full time_________/ Part time__________?  

Have you been convicted of a felony within the last 7 years?   Yes______ No_______. If yes please
explain:

___________________________________________________________________________________________

References: (give name, address and telephone of 3 references who are not related to you and are NOT
previous employers:
1__________________________________________________________________________________________

2.__________________________________________________________________________________________

3.__________________________________________________________________________________________


Special skills or hobbies:
_______________________________________________________________________

___________________________________________________________________________________________

State any additional information you feel may be helpful to us in considering your application:

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________


Final Information:

Please attach your years of completed of Education  (Name &addresses of schools and years attended).

Please attach your past Employment History (starting with your most recent job).  We need name of
company, address and phone number along with description of your job title and duties performed. Also
please fill in the dates you worked for this company.


Application Process:
Return your completed application to us either via email at:   lisa@empirerollerrink.com     or drop it off or
mail it to:  1305 Business Loop 70E, Columbia Mo   65201.  Please call ahead (443-7375) to make sure
we are open for you to hand it in.

If you have not heard from us within 7 days from receiving your application that means we have either filled
the job position or are considering other applicants.   DO NOT CALL to check on the status of your
application we will contact you to set up an interview if we are considering you.

Thank you.  Lisa Trent Owner