Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you 18 years of age or older? *

Yes

No

Are you currently employed? *

Yes

No

Are you a U.S. citizen and authorized to work in the U.S.? *

Yes

No

Have you been convicted of a felony in the last 7 years? *

Yes

No

May we contact this employer? *

Yes

No

I certify that all the information in this application is true and complete. I authorize Bullmoose, Inc. (The Iroquois Club) to investigate all statements in my application, including records of any former employers, doctors, hospitals, police departments, credit agencies and other services concerning me, and authorize such sources to release such information without liability. I waive any written notice of the release of such records as may be required by a state or federal law. I AGREE THAT ANY EMPLOYMENT RELATIONSHIP WITH BULLMOOSE, INC. WILL BE ON AN AT-WILL BASIS, WHICH MEANS THAT I MAY RESIGN AT ANY TIME OR BULLMOOSE, INC. MAY DISCHARGE ME AT ANY TIME, WITH OR WITHOUT CAUSE OR NOTICE. THIS AT-WILL EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED UNLESS IN WRITING AND SIGNED BY THE PRESIDENT OF BULLMOOSE, INC.. *

Agree

Do not agree

Digital signature *

First Name

Last Name