Personal Information:
First Name:
Last Name:
E-Mail:
Home Number:
Alternate Number:
Address:
City:
State:
Zip Code:
Employment Information:
Position Desired
Second Choice
Date you can start
Salary Expectation
How were you referred to us?
Do you desire:	Full Time Part Time On Call Temporary   If Temporary, provide dates:
Are you willing to work	Weekends? Yes No     Holidays?  Yes No          Days?  Yes No          Nights?  Yes No Flexible work schedule? Yes No     Overtime work? Yes No
Work Experience:  List most recent employment first. Ok to contact present employer(s)?  Yes No
Employer 1
Company Name
Address
Phone:
Dates (Month/Year):	From    To
Ending Pay Rate:	$
Position Title:
Supervisor:
Reason for Leaving:
Employer 2
Company Name
Address
Phone:
Dates (Month/Year):	From    To
Ending Pay Rate:	$
Position Title:
Supervisor:
Reason for Leaving:
Employer 3
Company Name
Address
Phone:
Dates (Month/Year):	From    To
Ending Pay Rate:	$
Position Title:
Supervisor:
Reason for Leaving:
Education:
High School
School Name
Addresss
Major:
Years Completed:	1 2 3 4
Graduate?	Yes No
Degree:
College
School Name
Addresss
Major:
Years Completed:	1 2 3 4
Graduate?	Yes No
Degree:
Business or Trade
School Name
Addresss
Major:
Years Completed:	1 2 3 4
Graduate?	Yes No
Degree:
Special Skills or Training:
List any training or job-related skills which should be considered:
Other Information:
Have you ever been employed with Skidmore Development?  No Yes Year Separated:      Where?
If you are applying for a position which may require the serving and handling of alcohol, do you meet the legal age requirements for this state?  Yes No
Have you ever been convicted of a felony?  No Yes If Yes, please explain in the space provided below.  A conviction does not include those that have been judicially expunged, sealed or eradicated.  A conviction record will not necessarily disqualify an applicant.  We will take into consideration such factors as nature, date and severity of offense, rehabilitation and job-relatedness.
Are you able to perform the essential job functions for which you are applying with or without accommodation?  Yes No
References:
List three persons to whom you are not related who are qualified to judge your training or capabilities that we may contact.
Reference 1
Name
Business or Occupation:
Years Known:
Home or Business Address
Phone Number
Reference 2
Name
Business or Occupation:
Years Known:
Home or Business Address
Phone Number
Reference 3
Name
Business or Occupation:
Years Known:
Home or Business Address
Phone Number
This section is optional VOLUNTARY AFFIRMATIVE ACTION FORM
John Skidmore Development Inc, John Skidmore Inc., and Flatwoods Factory Stores Inc. are Equal Opportunity Employers. We consider employees/applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected class. As required by law, we must record certain information. Applicants are invited to participate in the Affirmative Action Program by reporting their status as minority, disabled veteran or other veteran status, or other disabled. In extending this invitation you are advised that: 1) you are under no obligation to respond, but may do so in the future if you choose; 2) responses will remain confidential; and 3) responses will be used only for the necessary reporting. In an effort to help us comply with legal record keeping requirements regarding Affirmative Action, we ask that you complete the information requested below. Please be advised that your completion of this form is NOT part of your official application for employment. It is considered confidential information that will not be used in any hiring decision. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. If you choose to participate by completing this form, we thank you for your cooperation.
Section 1: General Applicant Information – Please complete
Applicant Name
Date
Position Held or Position Applied for
Section 2: Applicant Affirmative Action Data – Please complete
A. Gender:  Please Select ONE Male Female B. Race/National Origin – Check the space below that corresponds to the category that best identifies your race/ethnicity. IMPORTANT: If you check the “Two or more races” box, please also check ALL boxes that identify your race/ethnicity. For example: If you identify yourself as Asian and Black, you would check 3 boxes – one for Black, one for Asian and one for Two or more races. Race/Ethnic Category with Definitions of Category Hispanic or Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race). White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa). Black or African American (A person having origins in any of the black racial groups of Africa). Native Hawaiian or Other Pacific Islander (A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands). Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam). American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment). Two or more races (NOT Hispanic or Latino) All persons who identify with more than one of the above races. Do not wish to identify (All persons not wishing to self-identify race/ethnicity). C. Veteran Status* - Please check all boxes below that apply. Identification of veteran status is essential for effective affirmative action data collection and analysis. If you choose to identify your veteran status, the information you provide will be used for statistical purposes only and will not affect your employment in any way. Veteran Status* Definition Vietnam Era Veteran. Veteran of the Vietnam Era: A person who (I) served on active duty in the U.S. military, ground, naval, or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases; OR; (II) was discharged or released from active duty in the U.S. military, ground, naval, or air service for a service connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (B) between August 5, 1964 and May 7, 1975, in any other location. Special Disabled Veteran. Special Disabled Veteran: A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans’ Affairs for a disability – a) rated at 30% or more; b) rated at 10 or 20% in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap; or c) a person who was discharged or released from active duty because of service connected disability. Other Eligible Veteran. Other Protected Eligible Veteran: Veterans who served on active duty in the U.S. military, ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge, a service medal, or an expeditionary medal has been authorized. To identify campaigns or expeditions that may meet this criteria, you may visit the following website: www.opm.gov/veterans/html/vgmedal12.htm or send an email to othervets@vets100.com to request a copy of the list. Newly Separated Veteran. Newly Separated Veterans: Any veteran who served on active duty in the U.S. military, ground, naval or air service during the past one-year period, beginning on the date of such veteran’s discharge or release from active duty. Not Applicable. *According to 41 CFR 60-250.42, there are only two circumstances under which an employer may ask applicants who are Special Disabled Veterans to self-identify on a pre-offer basis: 1) The invitation is made when the contractor actually is undertaking affirmative action for special disabled veterans at the pre-offer stage; or 2) the invitation is made pursuant to a Federal, State, or local law requiring affirmative action for special disabled veterans. D. Disability Status** – Please check the below box if applicable. Self-identification of disability status is essential for effective affirmative action data collection and analysis. If you choose to self-identify your disability status, the information you provide will be used for statistical purposes only and will not affect your employment in any way. Disability Status** Self-Identification Definition of Disability Individual with Disabilities A person has a disability if he or she has a physical or mental impairment which substantially limits one or more major life activities; has a record of such impairment; or is regarded as having such impairment. A handicap is “substantially limiting” if it is likely to cause difficulty in securing, retaining or advancing in employment. **According to 41 CFR 60-741.42, there are only two circumstances when an employer may ask a disabled applicant to self-identify on a pre offer basis: 1) The invitation is made when the contractor actually is undertaking affirmative action for individuals with disabilities at the pre offer stage; or 2) The invitation is made pursuant to a Federal, State or local law requiring affirmative action for individuals with disabilities.
End of Optional Section
Certification:
Applicant: Please read the following carefully and agree to all terms before submitting this application.  Submission of this Online Application is not possible until all terms are acknowledged and agreed to by selecting the check box below.
Online Application for the companies: John Skidmore Development Inc. (DBA Days Hotel, Sutton Inn, Flatwoods KOA, Mountain Lakes Amphitheater), Flatwoods Factory Outlet Stores Inc., John Skidmore Inc. (DBA Sutton Lane Motel)
I understand that the companies prohibit the employment of relatives in direct reporting relationship.  In the event that such a relationship arises, I understand that I may be ineligible for continued employment or may be required to transfer to another position. I authorize the companies to investigate all statements contained in this application and/or resume supplied.  I authorize these persons, schools, and employers named in this application to provide the companies with all relevant information needed to evaluate my qualifications and release those persons, schools, and employers from any liability for disclosure of such information. I declare that my answers to the questions in the application are true to the best of my knowledge and belief.  I understand that any false statements appearing on this or any other Company provided form will be sufficient reason not to hire me, and if discovered after my employment, may result in termination. I understand that my employment is "at will" which means that if employed, my employment and compensation can be terminated, with or without cause, and with or without notice, at any time at the option of either the Company or myself.  No one other than the Chairman of the Company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.  I understand that the policies and procedures of the Company are guidelines for the governance of employment and that the Company retains ultimate and complete discretion in the application and revision of such policies and procedures. This application expires 90 days after the date of the submission of this form. I understand if hired, I will be required to present documentation proving my eligibility to work in the United States pursuant to the Immigration Reform Control Act of 1966 Applicants may be subject to pre-employment drug test. To build a diverse workforce, the Skidmore companies encourage applications from individuals with disabilities, minorities, veterans, and women. EEO/AA employer.
I have read and agree to the above terms and conditions.