Job Application * = Required Full Name Address State*CaliforniaAlabamaAlaskaArizonaArkansasColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming If less then 2 years, previous address: StateCaliforniaAlabamaAlaskaArizonaArkansasColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Date Available to work? Are you willing to work any shift, including evenings and weekends?*YesNo Are you a citizen of the United States?*YesNo If no, are you authorized to work in the U.S.?YesNo Have you ever been convicted of a felony?* YesNo Education From To Did you graduate?YesNo When? From To Did you graduate?YesNo When? From To Did you graduate?YesNo When? Certifications Do you currently have a Personal Trainer Certification?YesNo If yes: Certificate Expiration Do you currently have any Group Exercise/Aerobics Certifications?YesNo If yes: References References 1 Please list three professional references References 2 References 3 Previous Employment Job 1 From To May we contact your previous supervisor for a reference?YesNo Job 2 From To May we contact your previous supervisor for a reference?YesNo Job 3 From To May we contact your previous supervisor for a reference?YesNo Terms It is the policy of The House That Ruth Built, Inc. dba The Energy Lab to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status. CERTIFICATION I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize The House That Ruth Built, Inc. dba The Energy Lab to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of The House That Ruth Built, Inc. dba The Energy Lab, except in a specific written contract of employment signed on behalf of the organization by its Owner, has the power to alter or vary the voluntary nature of the employment relationship. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.