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Employment Application

Employer: Skidaddles, Inc. Address: 8660 Bankers Street City/State/Zip: Florence, Kentucky 41042 Telephone: (859)647-7529

Employer: Skidaddles of Mason, Inc. Address: 5939 Deerfield Blvd., Suite 104 City/State/Zip: Mason, Ohio 45040 Telephone: (513) 204-3482

It is the policy of Skidaddles, Inc. and Skidaddles of Mason, Inc. 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.

Which Location are you Applying for? Florence Mason   About You: Applicant Name: Address: City: State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Number of years at this address: Daytime phone: Evening phone:   More Info: Job Position Applied For: Salary Desired: $  per Who referred you to our company? Have you applied to our company previously? Yes No If yes, when? Are you at least 18 years old? Yes No Are you willing to work any shift, including nights and weekends? Yes No If no, please state any limitations: Are you looking for part-time, full-time, or seasonal employment Full-Time Part-Time Seasonal If you are offered employment, when would you be available to begin work? Please list your available days and times to work below Are you legally eligible for employment in the United States? Yes No Are you able to perform the essential functions of the job position with or without reasonable accommodation? Yes No   What reasonable accommodation, if any, would you require?      Have you ever been convicted of any crime, including traffic violations? Yes No If yes, please describe: CONVICTION WILL NOT SERVE AS AN AUTOMATIC BAR TO HIRING. CIRCUMSTANCES OF CONVICTION WILL BE CONSIDERED. Applicant Employment History: List your current or most recent employment first. 1. Employer Name: Address: City: State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Job Duties: Reason for Leaving: 2. Employer Name: Address: City: State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Job Duties: Reason for Leaving: 3. Employer Name: Address: City: State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Job Duties: Reason for Leaving: Applicant's Education and Training: List your education and training. High School Name and Address: Last Grade? 9th 10th 11th 12th Diploma? Yes No College Name and Address Did you receive a degree? Yes No If yes, degree received: Other Training (graduate, technical, vocational): Awards, Honors, Special Achievements: References: List any two people who would be willing to provide a reference for you. 1. Name: Address: City: State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Telephone: Relationship: 2. Name: Address: City: State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Telephone: Relationship: Please provide any other information that you believe should be considered: 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 Skidaddles, Inc. and Skidaddles of Mason, Inc. 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 President, the employment relationship will be entirely voluntary in nature. In other words, 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 would have the same right. Moreover, no agent, representative, or employee of Skidaddles, Inc. or Skidaddles of Mason, Inc., except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION. I UNDERSTAND AND AGREE TO ITS TERMS.    No Yes Type in your Full Name below. This will be used as your electronic signature.

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