ADDRESS:

APARTMENT/SUITE:

CITY:

STATE: ZIP:

DAYTIME PHONE:

E-MAIL ADDRESS:

2) EDUCATION:
(Select all that apply)

Bachelor's Degree
Major:

Master's Degree
Major:

Ph.D.
Major:

Other (specify)
Major:

3) CERTIFICATION:
(Select all that apply)

ACE
ACSM
AEA
AFAA
ISSA
NASM
NSCA-CPT
Other (specify):

4) ADVANCED CERTIFICATION OR LICENSURE:
(Select all that apply)

ACSM Exercise Specialist
ACSM Exercise Testing Specialist
ACSM Fitness Director
Certified Athletic Trainer (ATC)
Certified Strength and Conditioning Specialist (CSCS)
Registered Dietitian (RD)
Licensed Dietitian (LD)
Physical Therapist
Other (specify):

5) JOB EXPERIENCE:
(Select all that apply)

Educator
Personal Trainer
Personal Training Director
Group Fitness Instructor
Group Fitness Director
Dietitian
Fitness Director
Fitness Center Owner
Fitness Center Manager
Physical Therapist
Athletic Trainer
Other (specify):

6) Do you have at least one year of continuous work experience in Fitness or a related field since graduation from college?

YES
NO

7) Do you live within 50 miles of a major airport?

YES
NO
If yes, which airport?

8) Are you available for out of town travel approximately once every 4 - 6 weeks?

YES
NO

9) At what time are you available to travel on Fridays?
(Choose only 1 time)

Anytime
After 12 noon
After 2 PM
After 3 PM
After 4 PM
After 5 PM
After 6 PM
After 7 PM
After 8 PM
After 9 PM
It varies from week to week

10) Do you understand that this is a short-hour, contract teaching position entailing approximately one weekend assignment every 4 – 6 weeks?

YES
NO

11) Please describe briefly why you feel you are qualified for this position.

12) Please use this space for additional comments or statements.

13) ABOUT EXERCISE ETC
Exercise ETC Inc is an equal opportunity employer. Exercise ETC does not discriminate based on age, gender, race, ethnicity, marital status, political / religious affiliation or sexual orientation. Exercise ETC is a drug free workplace and abides by all state and federal laws governing the workplace. More details about our company may be found on our website: www.exerciseetc.com

Do you understand the above statement?
YES
NO

14) STATEMENT:

This application is submitted voluntarily. You understand that this on-line application is the first step of a process that may culminate in the offer of a part time faculty position with Exercise ETC Inc. You understand that, in the future, as part of this application process Exercise ETC may request a copy of your resume, a list of professional and personal references, more details on your work experience and your college transcripts and proof of graduation. You verify that all information submitted is true and correct to the best of your knowledge at this time.

Do you understand and agree with the above statement?
YES
NO

Your name: Date: