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PERSONAL INFORMATION

Last Name: First Name:

Street Address:

State: Zip Code: Phone Number:

Birthdate: Social Security Number:

Do you have a valid Drivers License? If yes, for what state?

Drivers License Number: Exp. Date:

Have you ever been convicted of a crime? If answered yes, Explain (Such a

conviction be relavant if job related, but does not bar you from employment.)

Position Desired:Date Available to start:

Are you available for: Full-TimePart-TimeOvertimeNights/Weekends

How did you hear about this positon:

EDUCATION

Name/ Address

Did you Graduate?

Major/ subjects of study?

High School:

College/University:

Business/ Trade:

Please list areas of highest proficiency, special skills or certifications that may contribute to

your abilities in performing at this position.

EMPLOYMENT HISTORY

1. Employer:Phone Number:

Address: Position Held:

Dates of Employment:

Reason for Leaving:

Supervisors Name:Phone:May We Contact:

2. Employer:Phone Number:

Address: Position Held:

Dates of Employment:

Reason for Leaving:

Supervisors Name:Phone:May We Contact:

REFERENCES

Name:Relationship to You:Phone:

I,, acknowledge that I have been advised that an employment related

consumer report may be in connection with my application for employment with Court Time

Sports Center, LLC. and/or in connection with any periods of employment, should I be considered

for employment by Court Time Sports Center, LLC. Such consumer report may be an investigative

consumer report that might contain information as to my character, work habits (including

reasons for termination from past employment) general reputation and personal characteristics.

This information may be obtained through personal interview with associates, or others with who

I am acquainted or who may have knowledge concerning such information. I authorize Court

Time Sports Center, LLC to make whatever inquiries it deems necessary in connection with my

application for employment or in the course of review of any employment. I authorize all

persons, schools, companies, corporations, department of motor vehicles, and law enforcement

agencies to supply information concerning by background to Court Time Sports Center, LLC., and

its agent HR Screening Services. I release Court Time Sports Center, LLC., and HR Screening

Services, concerning me, from all liability or any damages on account of inquiry into and the

furnishing of said information. (Year of birth may be required to access some criminal records

information. It may be necessary for HR Screening Services to contact the applicant and obtain

the actual year of birth. The year of birth will be used only for the purpose and will not be

divulged to Court Time Sports Center, LLC.)

A photocopy of this authorization shall be deemed an original and shall be accepted as such

by every person. I understand that I have the right to request a copy of any report at no charge

by writing to HR Screening Services within 60 days. As per the Fair Credit Reporting Act, I am

entitled to know if employment is denied because of information obtained from a consumer

reporting agency such as HR Screening Services.

I have read and understand the following information and accept that the following

information provided is correct.