Employment Application Personal Information Name* Address* Email* Phone Number* Are You 18 Years of Age or Older?* ---YESNO Tell us about your climbing history* Education History Years of High School?* Did you Graduate?* ---YESNOIn Progress Years of College? Did you Graduate? ---YESNOIn Progress Years of Graduate School? Did you Graduate? ---YESNOIn Progress Years of Trade School? Did you Graduate? ---YESNOIn Progress What Are You Looking For? Position* Location * ---BloomingtonMinneapolisSt PaulTwin Cities BoulderingRoute SettersDuluthGlendale Heights Desired Start Date * MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day12345678910111213141516171819202122232425262728293031 Year201720182019 How many hours are you looking for?* Up to 1212-2020-3535+ What days are you available to work?* SundayMondayTuesdayWednesdayThursdayFridaySaturday What time of the day are you most available to work?* MorningAfternoonEvening Hourly Pay Expected?* Work Experience Employer Position Hourly Rate Dates Employed From: To: Supervisor’s name Phone Number Reason for leaving May we contact YesNo Employer Position Hourly Rate Dates Employed From: To: Supervisor’s name Phone Number Reason for leaving May we contact YesNo Employer Position Hourly Rate Dates Employed From: To: Supervisor’s name Phone Number Reason for leaving May we contact YesNo References Name* Relationship:* Phone* Name Relationship: Phone Name Relationship: Phone Questionnaire Do you know how to tie a figure eight knot and a back up knot?* ---YESNO Do you know what double backing your harness is?* ---YESNO Do you know what the Yosemite decimal system is?* ---YESNO Do you know the Belay commands?* ---YESNO Do you know how to Top Rope Belay?* ---YESNO Do you know how to Lead Climb?* ---YESNO Do you know how to Lead Belay?* ---YESNO Do you know what a Z Clip is?* ---YESNO Do you know what a Back Clip looks like?* ---YESNO Have you ever applied for employment with us?* ---YESNO Are you legally eligible for employment in the US?* ---YESNO Did you serve in the U.S. Armed Forces?* ---YESNO If “yes”, which branch? Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which have not been annulled, expunged, or sealed by a court? ---YESNO If “yes” please describe in full. Other applicable training or skills: Medical Questionnaire All persons are required to furnish health condition information and if necessary, submit to an examination by a company designated physician. This information will be used to determine appropriate job placement. It shall not be used to disqualify an otherwise qualified person who may have a mental or physical disability. These questions pertain to the essential function of the job. Do you have any condition or have you sustained any injury that would have effect on your capacity to perform the duties of this position with or without reasonable accommodations? * ---YESNO Do you have any back problems or have you sustained any back injuries? * ---YESNO Have you had any serious wrist problems including carpal tunnel syndrome? * ---YESNO Can you perform these functions or tasks? Stand for long periods of time during your shift? * ---YESNO Bend and stoop for long periods of time during the day? * ---YESNO Lift and/or carry up to 50lbs or more if required during your shift? * ---YESNO Work around dust and debris and wear a respirator if required? * ---YESNO Wear proper safety equipment – hard hats, goggles, glasses, respirators, etc.? * ---YESNO Grip, grasp, or twist using your hands and wrists regularly during your shift? * ---YESNO Work a ten-hour shift if required? * ---YESNO Reach over your head with 25-35 lb. loads regularly during your shift? * ---YESNO Climb stairs with loads regularly during your shift? * ---YESNO Understand hazardous communication and safety information? * ---YESNO Employment Status Please carefully read the following: 1. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. 2. I understand that my employment with Vertical Endeavors Inc. is subject to a probationary period of ninety (90) days, during that time my employment will be considered temporary in status. In addition, Vertical Endeavors Inc. resources the right to terminate my positions within this time for any reason. 3. I understand that Part-time employees must be available to work a minimum of three (3) shifts per scheduled week. Not being able to work this minimum could result in loss of employment benefits and /or position. All employees are also required to be available to work special events and competitions. 4. The information provided in this application for employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal I understand and agree to the terms above: * ---YESNO Part-time employees must be available to work a minimum of three (3) shifts per scheduled week. Not being available to work this minimum could result in loss of employee benefits and/or position. All employees are required to be available to work special events and competitions. The information requested is needed for legally permissible reasons, including, without limitations, national security considerations, legitimate occupational qualification or business necessity. The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex, or national origin. Federal law also prohibits discrimination based on age, citizenship and disability. The laws of most states also prohibit some or all of the above types of discrimination as well as some additional types such as ancestry, marital status, and sexual preference. Vertical endeavors uses Direct Deposit Payroll. Direct Deposit Payroll Policy allows the company to deposit your payroll check directly into a bank account of your choosing (checking/saving) rather than issuing a paper check. The money will be in your bank account the morning of the scheduled pay dates. By submitting this application, you are submitting an application for employment that is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in your dismissal. By submitting this application you are authorizing Vertical Endeavors, Inc. to examine any and all criminal records and arrests on file. In doing so, you understand that you are waiving your right of confidentiality.