Employment Application Form Name* First Last Preferred Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email Date of Birth*Social Security #*Cell Phone #*List names and contact information for 3 References--2 of which should be employment-related.Name Place of Employment Phone # Work Performed Dates of Employment Name Place of Employment Phone # Work Performed Dates of Employment Name Place of Employment Phone # Work Performed Dates of Employment Please answer the following questions:Do you have any experience working with children? If yes, please explain.*Please explain why you want to work at Butter and Egg Adventures.*If you are currently enrolled in college classes, please include when you are in class and if you have any weekly commitments.*Please list if you have any current lifeguard, CPR challenge course, or similar certifications.Have you even been convicted of any crime, including sex related or child abuse related offenses? If yes, please explain.*Do you have any disabling conditions in which accommodations must be made in order for you to perform work duties? If yes, please explain.*Please check any box that applies.* I can swim I use tobacco I am fearful of working in heights If you have any medical conditions, or take prescription drugs of which the managerial staff should be made aware of, please supply us with this information upon accepting employment in order for us to aid in emergency treatment should it be necessary.In case of emergency, please contact:Name* First Last Phone*Relationship*By placing my initials in this box, I hereby affirm that all information that I have provided is accurate and complete.*It is the policy of Pierce Enterprises, LLC and Butter and Egg Adventures, LLc to promote and ensure equal employment opportunity for all persons regardless of race, color, national origin, religion, age and disability.NameThis field is for validation purposes and should be left unchanged.