COWTOWN COLISEUM APPLICATION

Personal Data

Name: (last, first, middle) __________________________________________________

Date: ___________________  Social Security #: ________________________________

Address: ________________________________________________________________

City: _________________________ State: _________________ Zip: _______________

Home Phone: _____________________  Other Phone: ___________________________

Position Applying For: ___________________________________

Education

High School: ________________________________ Date Attended: _______________

College: ____________________________________ Date Attended: _______________

Employment (begin with the most recent)

Employer: __________________________________ Dates: ______________________

City: _________________________ State: ________________ Zip: ________________

Phone: ______________________

Beginning Pay: __________________  Ending Pay: _______________________

Title/Duties: _____________________________________________________________

Reason for leaving: _______________________________________________________

Employer: __________________________________ Dates: ______________________

City: _________________________ State: ________________ Zip: ________________

Phone: ______________________

Beginning Pay: __________________  Ending Pay: _______________________

Title/Duties: _____________________________________________________________

Reason for leaving: _______________________________________________________

Employer: __________________________________ Dates: ______________________

City: _________________________ State: ________________ Zip: ________________

Phone: ______________________

Beginning Pay: __________________  Ending Pay: _______________________

Title/Duties: _____________________________________________________________

Reason for leaving: _______________________________________________________

References (List 3 professionals who have known you at least 2 years.)

Name: _________________________  Position: _________________________

Phone: _______________________ Relationship: _______________________

Name: _________________________  Position: _________________________

Phone: _______________________ Relationship: _______________________

Name: _________________________  Position: _________________________

Phone: _______________________ Relationship: _______________________

The information provided herein is true, correct, and complete. If employed, false statements or omissions of the facts on this application may result in dismissal. I understand that if employed, such employment is for indefinite period and is subjected to change in wages, conditions, benefits, and operating policies. I further understand that acceptance of an offer of employment does not create a contractual obligation upon the company to continue to employ me in the future. I hereby grant permission to the company to make the necessary inquires to ascertain my background and to consult with any and all references and prior employers listed in this application. I hereby acknowledge that I understand that should I become employed with this company and during the course of my employment the company chooses to provide medical care and treatment for on-the-job injury, or should the company continue to pay certain benefits during any period of my incapacity to work, these payments or care are not considered by me as an admission of liability on the part of the company.

Applicant Signature: _____________________________________

Date: ________________________