Exceptional Experiences
Columbia Hospitality

Thank you for applying at Columbia Hospitality, Inc. We are a team of enthusiastic individuals who create raving fans (internally and externally) every day. We appreciate your interest in joining us.

* Indicates a required field.

Personal Information
Today's Date: 20/11/2008
Name: * (Last, First, Middle)
Social Security Number: *
Address: *
City: *
State: *
Zip Code: *
Home Phone: * (###) ###-####
Business/Message Phone: (###) ###-####
Email Address:
Other names by which you are known:
How were you referred to
Columbia Hospitality, Inc.?
Are you legally eligible for employment in the U.S.? Yes No
Are you less than 18 years of age? Yes No
Have you been convicted of a crime? Yes No
If Yes, list convictions that are a matter of public record (arrests are not convictions).
A conviction will not necessarily disqualify you for employment.
Did you sign a Non-Compete, Non-Disclosure, or any other restrictive agreements that would prevent you from employment with Columbia Hospitality Inc.?  Yes No
 
Employment Desired
Position Desired:
Location:
Wage Desired:
Date you can start:  (DD/MM/YYYY)
Have you previously been employed by
Columbia Hospitality Inc. properties? Yes No
If Yes, give dates and locations of employment:
 
Please Note Schedule Availabilty
Mon. Tues. Wed. Thurs. Fri. Sat. Sun.
AM 
PM 
 
Employment Record
Are you currently employed? Yes No
List below your three most recent employers, starting with the most recent one first.
 
Employment 1
Position
Title
Salary or Hourly Wage1
Start   End   Hours/week
 
Employer
Name Supervisor
Address Phone Number
(###) ###-####

May we contact? Yes No
 
Details
Duties Performed Employment Dates (DD/MM/YYYY)
From To
Reason for leaving  
 
Employment 2
Position
Title
Salary or Hourly Wage1
Start   End Hours/week
 
Employer
Name Supervisor
Address Phone Number
(###) ###-####

May we contact? Yes No
 
Details
Duties Performed Employment Dates (DD/MM/YYYY)
From To
Reason for leaving  
 
Employment 3
Position
Title
Salary or Hourly Wage1
Start   End Hours/week
 
Employer
Name Supervisor
Address Phone Number
(###) ###-####

May we contact? Yes No
 
Details
Duties Performed Employment Dates (DD/MM/YYYY)
From To
Reason for leaving  
1 Indicate base salary. If you include total compensation, please identify overtime, bonus, shift pay or similar consideration.
List and describe periods of unemployment of more than 60 days.
 
Education
Name and Location of School Years
Completed		 Graduated Degree Received
High School
Yes No
College
Yes No
College 2
Yes No
Post College
Yes No
Special Studies / Training
List all skills relevant to the position for which you are applying
References please provide the names of three professional references, which you have know for at least one year.
 
Reference One
Name How do you know this person? Years Aquainted Phone Numbers
(###) ###-####
Home Phone
Business Phone
Email
Employer Name
 Address
 
Reference Two
Name How do you know this person? Years Aquainted Phone Numbers
(###) ###-####
Home Phone
Business Phone
Email
Employer Name
 Address
 
Reference Three
Name How do you know this person? Years Aquainted Phone Numbers
(###) ###-####
Home Phone
Business Phone
Email
Employer Name
 Address
 
Disclosure and Authorization Form

Columbia Hospitality, Inc. (the “Company”) will procure a consumer report and/or investigative consumer report on you in connection with your employment application. Intelius, a consumer-reporting agency, will obtain the report for the Company. Intelius is located at 500 108th Avenue NE, Suite 1660, Bellevue, WA 98004, and can be reached at (425) 974-6100.

The report may contain information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. The types of information that may be obtained include, but are not limited to: credit reports, social security number verification, criminal records checks, public court records checks, driving records checks, educational records checks, verification of employment positions held, personal and professional references checks, licensing and certification checks, etc. The information contained in the report will be obtained from private and/or public record sources, including sources identified by you in your job application or through interviews or correspondence with your past or present coworkers, neighbors, friends, associates, current or former employers, educational institutions or other acquaintances.

The nature and scope of any investigative consumer reports that may be requested is explained above. You are nonetheless entitled to request more information about the nature and scope of such reports by submitting a written request to Human Resources, Columbia Hospitality, 2223 Alaskan Way, Seattle, WA 98121.

The Company is furnishing you with a summary of your rights under the Fair Credit Reporting Act in a form prescribed by the Federal Trade Commission.

AUTHORIZATION
I have carefully read and understand this notice and authorization form. By my signature below, I consent to the release of consumer and/or investigative consumer reports to the Company.

I understand that, to the extent allowed by law, information contained in my job application or otherwise disclosed to the Company by me before, during or after my employment, if any, may be utilized for the purpose of obtaining consumer reports and/or investigative consumer reports.

I understand that if the Company hires me, it may request a consumer report and/or an investigative consumer report about me, to the extent allowed by law, for employment-related purposes during and after my employment. I understand that my consent will apply throughout and after my employment unless I revoke or cancel my consent by sending a signed letter to Human Resources, Columbia Hospitality, 2223 Alaskan Way, Seattle, WA 98121.
 
Name: * (Last, First, Middle)
Present Address: *
City/State/Zip: *
Social Security Number: *
Driver's License Number: *
License Number: *
Professional License Number: * State  Type  Number 
 
For Identification Purposes Only
 
Date of Birth: *
Gender: *
 

I certify that the information given by me to Columbia Hospitality, Inc. is true and complete to the best of my knowledge. I understand that, if employed, false or misleading information may result in discipline up to and including immediate dismissal.

I authorize Columbia Hospitality, Inc. to solicit information regarding my character, general reputation, previous employment and personal characteristics. The types of information that my be obtained include, but are not limited to: verification of employment positions held, personal and professional references checks, licensing and certification checks, etc. The information will be obtained from a variety of sources, including through interviews or correspondence with individuals identified in this application, past or present coworkers, neighbors, friends, associates, current or former employers, educational institutions or other acquaintances. I hereby release all parties and persons connected with any such request for information from all claims, liabilities, and damages for any reason arising out of the furnishing of such information. If I become employed, I release Columbia Hospitality, Inc. from any and all liability than may arise as a result of any future references it may provide concerning my employment with the company.

I understand that nothing contained in the application, or conveyed during any interview which may be granted, is intended to create an employment contract. I understand that filling out this form does not indicate there is a position open and does not obligate Columbia Hospitality, Inc. to hire me.

If I become employed by Columbia Hospitality, Inc., I agree to conform to all company guidelines. I understand and agree that my employment is at will, which means that it is for no specified period and may be terminated by me or Columbia Hospitality, Inc. at any time without prior notice for any reason.

* I have read and understood the above disclaimer   Yes

 
COLUMBIA HOSPITALITY IS AN EQUAL OPPORTUNITY EMPLOYER