Application Form

Position Referred /
Applied For: Sourced by:

Complete Name: Nickname:

Address:

Email Address:

Telephone No.: Mobile No.:

SSS No: TIN:

Date of Birth: Place of Birth:

Education
From To Name of School / Address Course

Employment History (additional sheet may be provided)

From To Name & Address of Company Position Reason for Leaving

Please write other information regarding any job-related skills you have that you think would be relevant to us in considering
you for employment.

________________________________________________________________________________________
________________________________________________________________________________________________________
Professional Organizations/Affiliations

Certifications/Professional Board Passed

Business Reference (may include previous supervisors or direct reports)

Name Company Name / Position Contact Details

Character References (may include personal acquaintances or business colleagues)

Name Company Name / Position Contact Details

Disclosures
 Do you have any medical condition that may affect your abilities to carry out work duties? If YES, please specify the details.

 Do you have relative/s connected with Play Innovations, Inc. or those in the business of play space, children’s entertainment, theme
parks, etc.? If YES, please specify the details.

 Have you ever been arrested, indicted, or summoned into court as a defendant in criminal and/ or civil proceeding, or convicted, fined
or imprisoned or place on probation in connection with such proceeding, or have been arrested or required to deposit bail or
collateral for the violations of any law or regulation, civil or military? If YES, please specify the details.

 Have you ever been dismissed for violation of company policies by your previous employer? If YES, please specify the details.

 I hereby authorize the Company to conduct inquiries about my personal and employment records from my former employers,
personal and other references.

I agree to submit myself to physical and medical examination before and/or after employment and that I may be separated or
dismissed should the findings justify.

I hereby certify that the foregoing statements are true, complete and correct. I understand that if employed with Play Innovations,
Inc. (“COMPANY”) any false statement and/or dishonest answer hereinabove stated shall constitute a sufficient cause for my dismissal.

Signature of Applicant Date