Waybury Management Corp. 457 East Main East Middlebury, VT 05753 802-388-4015Waybury Inn

Employment Application

Applicant Information

Full Name:   Date: 
 LastFirstM.I.  
Address:  
 Street AddressApartment/Unit #
    
 CityStateZIP Code
Phone: Email 
Date Available: Social Security No.: Desired Salary:$
Position Applied for: 
Are you a citizen of the United States?YES NO If no, are you authorized to work in the U.S.?YESNO
Have you ever worked for this company?YESNOIf yes, when? 
Have you ever been convicted of a felony?YESNO 
If yes, explain: 
  Are you fully vaccinated for the Covid 19 virus? 

Education

High School: Address: 
From: To: Did you graduate?YESNODiploma:: 
College: Address: 
From: To: Did you graduate?YESNODegree: 
Other: Address: 
From: To: Did you graduate?YESNODegree: 

References

Please list three professional references.

Full Name: Relationship: 
Company: Phone: 
Address: 
    
Full Name: Relationship: 
Company: Phone: 
Address: 
    
Full Name: Relationship: 
Company: Phone: 
Address: 

Previous Employment

Company: Phone: 
Address: Supervisor: 
Job Title: Starting Salary:$Ending Salary:$
Responsibilities: 
From: To: Reason for Leaving: 
May we contact your previous supervisor for a reference?YESNO 
    
    
Company: Phone: 
Address: Supervisor: 
Job Title: Starting Salary:$Ending Salary:$
Responsibilities: 
From: To: Reason for Leaving: 
May we contact your previous supervisor for a reference?YESNO 
    
    
Company: Phone: 
Address: Supervisor: 
Job Title: Starting Salary:$Ending Salary:$
Responsibilities: 
From: To: Reason for Leaving: 
May we contact your previous supervisor for a reference?YESNO 

Military Service

Branch: From: To: 
Rank at Discharge: Type of Discharge: 
If other than honorable, explain: 

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature: Date: 

Application and our job offer do not constitute an employment contract.  The Waybury Inn is an employer at will and work may be discontinued, by both parties, with appropriate and reasonable notice. Individuals hired at the Waybury Inn agree to meet all responsibilities within their job description and follow the direction provided by supervisory and management staff.  Failure to carry out assignments may