Upper Merion Dance & Gymnastics Center, LLC.
Application for Employment
Personal Info
Last Name: First Name: SS#: - -
Home Phone: ( ) - Cell Phone: ( ) -
Address:
Street Apt City State Zip
Email: Screen Name: AIM / MSN
Employment Desired
Position: Date Available: Salary:
Dance & Gymnastics Experience
Dance
Please note years of experience in each of the following disciplines (participating in/teaching):
Ballet___/___ Ballroom___/___ Ballet, Pointe___/___ Break/Pop & Lock___/___
Creative Move.___/___ Hip-Hop___/___ Irish Step___/___ Jazz___/___
Lyrical___/___ Modern___/___ Tap___/___
Check if you are now or have ever been:
DEA Certified_____
Gymnastics
Check if you are now or have ever been:
KAT Certified_____ Safety Certified_____ Skill Evaluator Certified_____
Experience in years (participating in/teaching):
Classes ___/___ Competitive___/___ Maximum level___/___
Employment & Volunteer History (List last three employers, starting with the most recent)
Date & Rates Job Information Reason for Leaving
From Name & Address Position
To Last Supervisor
End Rate Phone
Date & Rates Job Information Reason for Leaving
From Name & Address Position
To Last Supervisor
End Rate Phone
Date & Rates Job Information Reason for Leaving
From Name & Address Position
To Last Supervisor
End Rate Phone
Other Experience
Other Activities & Interests: Note the number of years of experience you have with each of the following:
Arts & Crafts_____ Cheerleading_____ Color Guard/Baton_____ Drama_____
Martial Arts_____ Music_____ Rhythmic Gymnastics_____ Swimming_____
Other Certifications: Check if you are now or have ever been certified in:
Babysitting_____ CPR_____ First Aid _____ Lifeguard _____
Other Hobbies/Interests/Skills/Honors/Certifications:
References (List two persons not related to you, whom you have known for at least one year)
Name Address Phone Relation How long
Education (List the last three schools/educational institutions you have attended, starting with the most recent)
Dates Name & location of school Graduation date GPA Subjects studied
From:
To:
From:
To:
From:
To:
Courses: Check the course that you have enrolled in and completed with a C or higher:
Dance_____ Kinesiology_____ Psychology_____ Teaching____
Release
In consideration of Upper Merion Dance & Gymnastics Center, LLC.’s evaluation of my suitability for employment, I hereby
authorize the Company to perform all checks of credentials as allowed by law including, but not limited to, contacting present and
former employees, supervisors, co-workers, friends, business associates, or other individuals that the company, in its sole discretion,
believes may have relevant information regarding my suitability for employment. I further authorize the company to perform the
following checks on my credentials and such other checks as the company deems appropriate. I agree not to assert any claims or
courses of action of any kind against the company, its agents or employees, or any individual or entity contacted by the company,
rising out of the company’s investigation. I further release and forever discharge the company, its agents and employees, and the
individuals and entities contacted by the company or part of its investigation, from any and all claims, demands, actions, causes of
action, or suits of any kind as nature whatsoever arising from the company’s investigation of my credentials, including without
limitation claims for libel, slander or any other claims associated with providing a reference. I acknowledge that the company has
made no representation of any kind or to whether employment will be offered at the conclusion of its investigation.
Applicant Signature: Date: