Employment Application Form

Personal Information

Present Address
Previous Address
(If at a present address less than 2 years ago)

Employment Desired

  Position Desired
  Date You Can Start 
   Salary Desired

Have You Ever Worked at a Country Club Before?

Ever Applied to This Club Before?


Name & Location of School
Years Attended
Did You Graduate?
Subjects Studied
Grammar School
High School
Trade, Business, or
Correspondence School

General Information

  Special Training / Skills
U.S. Military or Naval Service 

Former Employers (Start with last one first)

Name & Address of Employer
Dates of
Reason for Leaving


Years Known

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified the statements on this application shall be grounds for dismissal. I authorize investigation of all contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal and otherwise, and release Benvenue Country Club from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of Benvenue Country Club 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, unless it is in writing and signed by an authorized Benvenue Country Club representative. Thais waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act (ADA) and other relevant federal and state laws.”

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Benvenue Country Club
100 Southern Blvd., PO Box 7606 Rocky Mount, NC 27804 (252) 443-2141

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