@

C ruBCORP'
APPLICATION FOR EMPLOYMENT
interested in your qualifcâtions. A clear utderstanding ofyour background aod work histor wil aid us in considering you for the posítion that best matches your qualifcations. Therefore, we encou¡age you to be as completc and æ speoific æ possible. In this application we are sometimes referred to as The Company. The Company is an equal opportunity

shive to provide a safe and healtbû¡l work environmeng ûee ofsubstance abuse, for the protection and safety ofour Emptoyee Partroers, Members and Guests. The Company not employe i¡dividuals who are required to be registered as a sex offender.

will

PLEASE PRINT

PLAINLY. USE INK ONLY PERSONAL
Social Security No.

MIDDLE
For reference purposes, have you worked or attended school under a former name? Ifyes, please list former ûame:

NO. STREET How many years at this address?_
fue you at least 16 years

Present Add¡ess

CITY
Telephone No.

STATE (For Message)

(Home)

Are you legally eligible for employment in the United

Stares? yes

t

Xo

ll]
Yes l-J

If hired,

can you tumish

proof.r y"s

lll

No

[J

old?

yes

f,

No R

Are you at leåst 18 years old?

No l-l

Have you worked here befoie or for any p¡operty ¿füliated with the

Companyf Yes

l]l

No

Lr

Ifyes, when and where?

Ifyou arc cunently employed with the Company or
Position you are primarily interested in:

an afñliate

ofthe Company, hêve you contacted your cunent supervisor? Yes

lll

No

ü

Full-Time

lll

Part-Time

ll

T".por".y

ü
Ifhired,
on what date will you be able to staf work?

Rateofpayexpected
What houn and days

$

perhour/week/montl/ycar

of the wcek would you be able to

If

you are applying for a position that may require driving a Company vehicle:

Doyouhaveavaliddriver'slicense?
Do you have a valid Chauffeurs

Yesfl NoË lî
No

Canyoufumishproof?yesÜ

NoË
l-'J
¡,fo

Starel]i State_

Lioense No License

license? yes

Ü

C"o you frr*ish proof? yes

Has your driver's license ever been suspended or

revoked? Yes

fI

l¡o

lf

lfyes, explain in

Some positions may requirc

mdonr¡ reasonable sspicion, post-accident æd/or preemploym€nt, druyalcohol scræaiog.

EDUCATION
Circlehighestlevelofeducationcompleted:

Elementary6

7 8 Highschool I 2 3 4
Location City,

College

1 2 3 4 5 6 7 I

A.

ItrOH SCHOOL, Name of Higb

Didyougrâduate? yes

fl

No

lf

lfnot,doyouhaveaoequivalenrydiptoma(GED)?

V*s

l]j

No

Ü
Did you graduate?

B.

COLLEGE/GRADUATESCHOOL
Name

&

Location

From To

Major

Degree

January 2009

EMPLOYMENT
Please give accurate, complete full-tirne and

and unemployment

must be accw¿tely and euthfr¡lly accounted EMPLOYMENT RELATED TO DISABILITY OR RETIÀBILITATION. Company Name./Address

All time

paf-time employment histor. Sta¡t with present or most recent employer. lnclude militar sewice and periods of self-employment for. DO NOT PüT "SEE RESUME," NOTE: YOU NEED NOT ÐeLAIN ANY GAPS IN

WeeklyPay NameÆitle of Supervisor Emplol&rent Dates (Montl/Year) To From

Iob Title/Basic Duties
Reason for Leaving
Mâv wê côntâct

uù ænt

emblôel?

f

wn[
ÌVeekly Pay

Name/Title of Supervisor Employment Dates (Montb/Year) To From
Job

TitldBæic Duties
Reason for Leaving

Campany Name/Address

Telephone

ïVeekly Pay Name/Title of Supervisor Employment Dates (Month/Year)
Job Title/Basic Duties Reason for Leaving

TO THE APPLICANT
Haveyoueverbeenconvictedofafelonyormisdemeanorcriminaloffense? Yes fl ì¡o fi In Callfomla, crlniml ofense æludæ any conviction more than 2 years oldfor a marìjuam-relaled oferce.

ArcyoucurrcntlyonProbationorParoleforafelonyormisdemeanorcrimi¡aloffense?

Yes

lf

In Calþmta, pleæe selæt N/A. Thii question regarding probalíon or paroleþr a crlnina! ofme does Are you required or have you ever been required to register on aoy t¡rye of Sexual Offender Registry?

Noñ Nle l]j you.* Yes LJ No Ll
not

pertaín to

...

If YES to any, describe in Ârll (including dates). Employment with The Company is contingent upon the successful completion of a background check according
Background Check Policy.

to The Company's

Ves Haveyoueverbeendischægedoraskedto¡esign? yes
Haveyoueverbeenrefusedabondbyanemployer?

Ç fJ

NoÜ No lj

Ifyes,explaininfi¡ll,

Have you wer had shortages or misunderstandings about merchandise or fi¡nds or anything of value at a place of employment?

yes

ff

¡¡o

Ü

If yes, explain in full,

AGREEMENT
I hereby certiff that the facts set fodh in the applicatioa are hue and comptete, and I agree that you may investigate my statements in order to verifl and expand upon the informalion given. I understand that as part ofnormal employment procedure, a routine inquiry may be made cooceming ioformation on my education, criminal and/or civil record, sexual offender regisry, driving record (ifapplicable), formerjob responsibilities, character, general reputation, credi! and other related information. I I release you and all narned former emptoyen, all credit sources, aud all other sou¡ces of such information, from any liâbility for releasing information to I understand that if I fail to answer any question, or if I givc misleading or incomplete answers to any question, that alooe is a sufücient basis for â failure to hire me, or if I have been hirod that alone is sufficient basis for my immediate termiaation. I ñ¡rther u¡derstand that this is aD application for einployment aûd that no êmployment coûmct is being offered. I agree aad acknowledge that should I beoomc employcd by The Company my employment ca¡t be terminated, v/ith or without oause or notice, at any time by myself or The Company.

you.

I have had fi.rll opportunity to

ask whatever questions I have about aDy

ofthe above statements.

DATE

APPLICANT'S SIGNATT.IRE

January 2009

Disclosure and Release of Information Authorization Form
All States Except Caliþrnia
Properfy and Applicant: Do not attach this form to Ennployrnent Application
'oProperty"), as either my potential employer, my existing employer, a potential client for my services, and LexisNexis Screening Solutions Inc. ("LexisNexis"), a consumer reporting agency, to retrieve information from all educational institutions, govemment agencies, companies, corporations, credit reporting agencies, law enforcement agencies at the federal, state, or county level, or individuals, relating to my past activities, and all information concerning my background, to supply any and all information concerning my background. The information received may include, but is not limited to, academic, residential, achievement, job performance, attendance, litigation, personal history, credit reports, driving history, sexual offender registry and criminal history
records.

I authorize

Property's policy guidelines below:

I understand the following background checks are the current minimum requirements according to the if applying for or already working in certain critical positions as described

r Positions that may involve driving a vehicle as a regular part of the job require MVR checks. c All positions, including but not limited to independent contractors, require criminal checks e
(County, Federal, and Sexual Offender Registry [SOR]). Accounting/financial, General Manager, General Manager in Training, and certain Society and Owner's Club positions, as well as solo independent conttactors performing similar functions/services, require credit history checks, and I understand credit-reporting agencies, credit/bankruptcy litigation, and credit reports may also be included.

If applying for work and currently employed elsewhere, my current ernployer may be contacted. EYES ENO E N/A
If employed in Minnesota or Oklahorna, f would like
a copy of any consumer

report regarding me.

EYESENOONiA
consumer report may be prepared summarizing this information. ff my prior employers, clients, and/or references are contacted, the report may include information obtained through personal interviews regarding my character, general reputation, personal characteristics and/or mode of living. I may request a copy of any report that is prepared regarding me and may also request the nature and substance of all information about me contained in the files of the consumer reporting agency. I acknowledge that I have been given a copy of the Summary of Your Rights under the Federal Fair Credit Reporting Act.

I

understand that

a

Note: If the consumer checks *YES" regarding the consumer report, of if a California consumer checks *YES' regarding the credit report (and you do request a credit report), please fax this form to your LexisNexis Service Center. If a California consumer checks "YES" regarding the full consumer report, you will need to provide the individual with a copy of their consumer report. If the consumer checks "\ES" regarding the credit report, and you do request a credit report, please fax this form to Lexis Nexis at l-800-256-5876.

The following information IS NOT considered as part of your application for employment. It is used identification purposes. PLEASE PRINT CLEARLY Last Name: Driver's License Number:
Date of Birth:

for

First Name:
State of License:

Middle Name:
Expires On:
Phone Number:

Social Security Number:

Current.A.ddress: (No P.O. Boxes please)
Street Address:

City State Zip:
Previous Address:
Street Address:

(if at current

address for less than2 years)

City State Zip:

I HEREBY RELEASE ANY INDIVIDUAL, BUSINESS OR GOVER}IMENT ENTITY, INCLUDING ITS OFFICERS, DIRECTORS, EMPLOYEES AI\D AGENTS F'R.OM ANY AI\D ALL LIABILITY F'OR DAMAGES OF \ryHATEVER KIND, WHICII MAY REST]LT BECAUSE oF' CoMPLIA¡ICE, OR ATTEMPTED COMPLIANCE, Vt/ITrr THIS AUTHORTZATION A¡{D REQUEST TO RELEASE INFORMATION.
I have read, understand, and agree to the above and authoríze that a photocopy ofthis authorization shall be accepted with the same attthority as the origínal; and that if I become employed, volunteer, or contracted by any ffiliate of the above-named Property, or already am employed, volunteer, or contracted by any affiliate of the above-named Property, this release will remain in effect throughout my employment or contract or on-going relationship with the Property.

Signature

Date

Parent or Guardian Signature,

if under

18

Date

sometimes required
State

NOTARY: Currently required for StatewÍde Criminal Checks in AL, GA, NM, RI, WV, and WY; in MN depending on search.
County

of

Signature

My commission Expires on

A Summary of Your Rights Under the Fair Credit Reporting Act
Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response Centero Room 130-A 600 Pennsylvania Ave. N.W.,IVashington, D.C. 20580.

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rightso go to www.ftc.gov/credit or write to: Consumer Response Center Federal Trade Commission 600 Pennsylvania Ave. N.W., Room 130-A Washington, D.C. 20580.

r

You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment - or to take another adverse action against you - must tell you, and must give you the name, address, and phone number of the agency that provided the information. You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will tre free. You are entitlecl to a free file disclosure if: ô a person has taken adverse action against you because of information in your credit report; ö you are the victim of identify theft and place a fraud alert in your file; r your file contains inaccurate information as a result of fraud; . you are on public assistance; andlor i you are unemployed but expect to apply for employment within 60 days.
In addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www. ftc. gov/credit for additional information.

I

r

You have the right to ask for a credit score. Credit scores are numerical summaries of your creditworthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. You have the ríght to dispute incomplete or inaccurate information" If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.ftc.gov/credit for an explanation ofdispute procedures.
Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. lnaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it
has verified as accurate.

o

o

r

Consumer neponting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than l0 years old.

r r r

Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need -- usually to consider an application with a creditor, insurer,

employer, landlord, or other business. The FCRA specifies those with a valid need for access.

You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.ftc.gov/credit. You may limit (.prescreened'u offers of credit and insurance you get based on information in your credit report. Unsolicited'oprescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-5678688).

r o

You may seek darnages from violators. [f a consumer reporting agency, or, in some cases, a user consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

of

ldentity theft victirrs arad active duty military personnel have additional rÍghts. For more information, visit www.ftc.gov/credit.

States may enforce the FCRA: and many states have their own consurner reporting laws. In some cases, you may have more rights under state law. For more informationo contâct your state or local consumer protection agency or your state Attorney General. Federal enforcers are:

TYPE OF BUSINESS:
Consumer reporting agencies, creditors and others not listed below National banks, federal branches/agencies of foreign
banks (word "National" or initials "N.4." appear in or after bank's name) Federal Reserve System member banks (except

CONTACTI
Federal Trade Commission: Consumer Response Center

national banks, and federal branches/agencies of foreien banks) Savings associations and federally chartered savings
banks (word "Federal" or initials "F.S.B." appear in

federal institution's name) Federal credit unions (words "Federal Credit Union" appear in institution's name) State-chartered banks that are not members of the Federal Reserve System

- FCRA l-877-382-4357 Washineton. DC 20580 the Currency Office of the Comptroller of Compliance Management, Mail Stop 6-6 l-800-613-6743 Vy'ashinston- DC 20219 Federal Reserve Board Division of Consumer & Community Affairs l-202-452-3693 washinston. DC 20551 Office of Thrift Supervision Consumer Complaints l-800- 842-6929 Washinston. National Credit Union Administration 1775 Duke Street Alexandria. l-703-519-4600 Federal Deposit Insurance Corporation

DC2O552

VA223l4

Consumer Response Center 2345 Grand Avenue, Suite 100 Kansas City, Missouri 64108-2638 l-877-275-3342

Air, surface, or rail common carriers regulated by
former Civil Aeronautics Board or Interstate Commerce Commission Activities subject to the Packers and Stockyards Act,

Department o f Transportation

192t

Office of Financial Management l-202-366-1306 IVashinston. DC 20590 Department of Agriculture Office of Deputy Administrator - GIPSA l-202-720-7051 Washinston. DC 20250

BACKGROUND CHECK RECORI)
Do not attaclr the Díscloswre ønd R.eleøse of Inþrmøtion ,4wtkorízatíon Í7orm to the ^dpplication.

Name:

(Full Name of the current Employee Partner, prospective Employee Partner (including temporary/seasonal Employee Partner), or solo índependent contractor)
Date of Birth @OB): Position Applied

for:

An offer of ernployment is contingent upon the successful completion of a background check according to ClubCorp's Background Check Policy. If you begin employment prior to the completÍon of the background check, we reserve the right to terrninate youn
employment based upon background chech nesults.

Signature

Date

For office use only:

E ü

LexisNexis Account l{urnber: New [Iire Rehire

Requestor:
Date Background Check Requested: Date $[otificatíom of, Results Received:

Background Check Vendor:

Is this person eligible for ftrire, Rehire, Contract, Continued Contracto or Contínued
Employment?

E

v"s

ENo
Departrnent Head Signature Date