EMPLOYMENT APPLICATION BodySmart Wellness LLC / Masters-Center 680 Heacock Rd. Suite 204 Yardley, PA. 19067 215-493-1204 Please complete the entire application. It is the policy of BodySmart Wellness LLC / Masters-Center to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status. Applicant Full Name * RequiredHome Address * RequiredCity / State / Zip * RequiredNumber of years at this address * RequiredDaytime phone * RequiredEvening phone * RequiredMobile phone * RequiredEmail Address * Required Attach Resume HereAccepted file types: jpg, gif, png, pdf, doc, docx, txt, Max. file size: 1 GB.Website Address (If Any)Social Media Address(s) (Facebook, LinkedIn, Twitter, etc.)Note: If your social media page(s) requires that we be a friend or contact to view your page(s), please send us an invitation from your page(s) to the following addresses:Twitter https://twitter.com/BodySmartusa Facebook / MC-BSW https://www.facebook.com/BodySmartWellness/ LinkedIn BSW/MC https://www.linkedin.com/company/masters-center-bodysmart-wellnessYouTube https://www.youtube.com/channel/UCesPUB_I-QBZPCfC4-3q4nQ Social Security # * RequiredDriver's License (State & #)Previous AddressCity / State / ZipNumber of years at this address Emergency Contact - (Who should be contacted if you are involved in an emergency?)Contact NameRelationship to youAddressCity / State / ZipDaytime phoneEvening phoneJob Position Applied For * RequiredFull or Part Time? * RequiredAre you at least 18 years old? * Required Yes No How will you get to work? * RequiredAre you willing to work occasional nights and weekends if needed? * Required Yes No If no, please state any limitationsIf applicable, are you available to work overtime? * Required Yes No If you are offered employment, when would you be available to begin work? * RequiredIf hired, are you able to submit proof that you are legally eligible for employment in the United States? * Required Yes No Are you physically, mentally, emotionally, educationally, able to perform the essential functions of the job position you seek? * Required Yes No If “No” to the above, what reasonable accommodation, if any, would you need or request? Applicant's Skills(List any skills that may be useful for the job you are seeking. Include the number of years of experience.) Applicant Employment History List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.Employer NameContact Phone #Supervisor NameEmployer AddressCity/State/ZipJob DutiesReason for LeavingDates of Employment (Month/Year)Employer NameContact Phone #Supervisor NameEmployer AddressCity/State/ZipJob DutiesReason for LeavingDates of Employment (Month/Year)Employer NameContact Phone #Supervisor NameEmployer AddressCity/State/ZipJob DutiesReason for LeavingDates of Employment (Month/Year)Employer NameContact Phone #Supervisor NameEmployer AddressCity/State/ZipJob DutiesReason for LeavingDates of Employment (Month/Year)Employer NameContact Phone #Supervisor NameEmployer AddressCity/State/ZipJob DutiesReason for LeavingDates of Employment (Month/Year) Applicant's Education and TrainingHighest Year Of Education CompletedCollege/University Name and AddressDid you receive a degree? Yes No If yes, degree receivedHigh School/GED Name and AddressDid you receive a diploma? Yes No Other Training (graduate, technical, vocational)Please indicate any current professional licenses or certifications that you holdAwards, Honors, Special AchievementsThis Section - Military Vets Only:Military Service Yes No Served FromToBranchSpecialized TrainingType Of DischargeList Deployment(s) Reference: (List non-relatives and contacts outside of your household who would be willing to provide a reference for you.)Reference 1 Name Address City State / Province / Region ZIP / Postal Code TelephoneEmail RelationshipReference 2 Name Address City State / Province / Region ZIP / Postal Code TelephoneEmail RelationshipReference 3 Name Address City State / Province / Region ZIP / Postal Code TelephoneEmail RelationshipReference 4 Name Address City State / Province / Region ZIP / Postal Code TelephoneEmail RelationshipReference 5 Name Address City State / Province / Region ZIP / Postal Code TelephoneEmail RelationshipPlease provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employerCERTIFICATION I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize BodySmart Wellness LLC / Masters-Center to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I, the applicant, understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its , the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice (2 weeks unless otherwise agreed on by the parties), I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. If hired or contracted in any fashion, if any instance by the applicant/employee/contractor of theft, disclosure of any confidential information or any other improper or unethical action or behavior occurs on the part of the applicant/employee/contractor, BodySmart Wellness LLC management, may end any employment or contractual agreement at its discretion immediately and without notice. If and/or when any employment or contractual agreement terminates, the applicant/employee/contractor will turn in any keys or other property (including intellectual property) of BodySmart Wellness LLC / Masters-Center and/or its management immediately. Moreover, no agent, representative, or employee of BodySmart Wellness LLC / Masters-Center, except in a specific written contract of employment signed on behalf of the organization by its management, has the power to alter or vary the voluntary nature of the employment relationship. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.APPLICANT SIGNATURE * RequiredDATE * Required MM slash DD slash YYYY If any alterations are made to this document by the applicant, the application will be discarded and the applicant will not be considered for employment and/or contract now or in the future. Note: Applicant Agrees That When He or She Clicks The “Submit” Button, That Doing So, Will Be His or Her Electronic Signature.CAPTCHA Δ
