Employment

Clubhouse:	(563) 583-9158
Golf Shop:	(563) 583-9150
Fax:	(563) 588-3340

Dubuque Golf & Country Club
1800 Randall Place
Dubuque IA 52003
©2018 Dubuque Golf & Country Club. All Rights Reserved

Accepting Applications for all positions, especially Pool Servers, Bartenders, Line Cooks and Kitchen Prep, Dining Room Servers, Grounds Crew, and Cleaning/Maintenance.
*Once you have completed your answers, be sure to click the red “submit” button.
Today's Date*
Position(s) Desired* Bartender Host/Hostess Dining Room Server Line Cook Kitchen Prep Lifeguard Pool Server Grounds Crew Cleaning/Maintenance Other

First Name*	Last Name*
Phone*	Email*
PRESENT ADDRESS
Street and Number / City / State / Zip*
How long have you lived there?*
PREVIOUS ADDRESS
Street and Number / City / State / Zip*
How long did you live there?*

Select Days of Week Available (select all that apply) Sunday Monday Tuesday Wednesday Thursday Friday Saturday	Select Shifts Available (select all that apply) Days Afternoons Evenings Nights Part Time Full Time
Have you ever worked for this company before? Yes No	If yes, please give dates and position:
Have you ever pled guilty, or no contest to, or been convicted of a felony? Yes No	If yes, please give the date(s) and details:
Have you ever pled guilty, or no contest to, or been convicted of a misdemeanor resulting in imprisonment within the last seven years? Yes No	If yes, please give the date(s) and details:
Have you been arrested for any matters for which you are out on bail or on your own recognizance pending trial? Yes No	If yes, please give the date(s) and details:
NOTE: Answering "Yes" to these questions does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Do not include minor traffic citations and arrests or convictions which have been sealed or expunged in answering this question.)

RECORD OF PREVIOUS EMPLOYMENT Please list the names of your present and previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references (add additional page if necessary).

EMPLOYER #1
Name of Employer	Position
Employer Address	Supervisor’s name, title and telephone number
Describe work performed and scope of responsibilities
Date Employed (Month/Year)	Date Left (Month/Year)

EMPLOYER #2
Name of Employer	Position
Employer Address	Supervisor’s name, title and telephone number
Describe work performed and scope of responsibilities
Date Employed (Month/Year)	Date Left (Month/Year)
EMPLOYER #3
Name of Employer	Position
Employer Address	Supervisor’s name, title and telephone number
Describe work performed and scope of responsibilities
Date Employed (Month/Year)	Date Left (Month/Year)
EMPLOYER #4
Name of Employer	Position
Employer Address	Supervisor’s name, title and telephone number
Describe work performed and scope of responsibilities
Date Employed (Month/Year)	Date Left (Month/Year)
EDUCATION
High School
Name*	Location*
Field of Study*	Did you graduate? Yes No
College
Name	Location
Major	Minor
Did you graduate? Yes No	Honors Yes No
Degree Awarded
Graduate School
Name	Location
Degree Program	Degree Awarded
Did you graduate? Yes No	Honors Yes No

Are you at least 18 years of age? Yes No
If no, are you authorized to work, or, if necessary, can you obtain working papers? Yes No
Are you able to perform, with or without reasonable accommodation, the essential functions of the job for which you are applying? Yes No
Do you currently have the legal right to work in the United States? Yes No	Will you now or in the future require immigration sponsorship for employment visa status (e.g., H-1B visa status)? Yes No If yes, state work permit or visa type and expiration date.
Immigration Reform and Control Act (IRCA) The Immigration Reform and Control Act (IRCA) prohibits the employment of unauthorized aliens and further requires that if you are hired, the Company must verify your identity and your authority to work in the United States, even if you are a U.S. citizen. You are responsible for obtaining and providing the documentation required to perform the verification. (Information concerning this verification procedure and requirements is available upon request.)
REFERENCES Provide the names and contact information for three professional or equivalent references whom you have known for at least three years and are familiar with your work performance. References should not include immediate or extended family. Equivalent references can include academic references, such as professors, mentors, counselors, or advisors. Two references must be or have been individuals to whom you reported directly or provide the reason you cannot provide two supervisory references. Be aware that we will be contacting the references you have chosen to list below.
Reference #1 (Name, Contact Information, Relationship)	Reference #2 (Name, Contact Information, Relationship)
Reference #3 (Name, Contact Information, Relationship)	If not listed as a reference, may we also contact your present employer? Yes No
PLEASE READ AND SIGN BEFORE SUBMITTING: To the best of my knowledge, all of the information I have submitted on the Application is true and complete. I understand that any omission or falsification of information will be sufficient cause for disqualification from consideration for employment or dismissal from employment at the Dubuque Golf & Country Club. I voluntarily give the Dubuque Golf & Country Club the right to make a thorough investigation of my personal or past employment history and agree to cooperate in such investigation and I do hereby authorize any former employer, person, firm or corporation to give Dubuque Golf & Country Club any information they may have regarding me. In consideration for the Dubuque Golf & Country Club's review of the Application, I release Dubuque Golf & Country Club and all providers of information from any liability as a result of furnishing and receiving this information. I understand that any offers of employment are contingent upon successful completion of background checks. I understand employment at Dubuque Golf & Country Club is "at will," which means employment may be terminated by the employee or by the Dubuque Golf & Country Club at any time, with or without cause. I further understand employee benefits, terms, work hours, and conditions of employment and work rules may be changed from time to time by Dubuque Golf & Country Club without limitation. I also understand that any employment handbook or manual that may be distributed by Dubuque Golf & Country Club shall not be construed as a contract. If you apply for employment, are granted an interview time and miss that time, Dubuque Golf & Country Club may contact the Unemployment Office/Iowa Workforce Development to report your absence.
Signature (provide initials)	Date

EDUCATION

Immigration Reform and Control Act (IRCA)

REFERENCES