Applicant Name:

Address:

Telephone Number:

Email Address:

Date of Application:

How did you hear about this position?

What days are you available for work?

What hours or shift are you available for work?

If needed, are you available to work over time?

On what date can you start working if you are hired?

Salary desired

Have you ever applied to or worked for Gotham Unlimited,LLC before?

If yes, when?

Do you have any friends, relatives, or acquaintances working for Gotham Unlimited LLC If yes, state name & relationship:

Are you 18 years of age or older?

Are you a U.S. citizen or approved to work in the United States?

What document can you provide as proof of citizenship or legal status?

Do you have any condition which would require job accommodations?

If yes, please describe accommodations required below.

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Please list below the skills and qualifications you possess for the position for which you are applying:






(Note: Gotham Unlimited LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)

High School

Name	Location (City,State)	Year Graduated	Degree Earned

College/University

Name	Location (City,State)	Year Graduated	Degree Earned

Vocational /Specialize Training

Name	Location (City,State)	Year Graduated	Degree Earned

Military
Are you a member of the Armed Services?

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

References

Please provide 2 personal and professional reference(s) below:

Reference	Contact Information

Additional Information

Are you Licensed by the Department of Consumer Affairs?

If applicant holds a license what kind and when does it expire?

AT-WILL EMPLOYMENT

The relationship between you and the Gotham Unlimited LLC is referred to as “employment at will.” This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Gotham Unlimited LLC. No representative of Gotham Unlimited LLC has authority to enter into any agreement contrary to the foregoing “employment at will” relationship. You understand that your employment is “at will,” and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company’s President.