I certify that the information given on this application is true to the best of my knowledge and understand that falsification of this information is grounds for dismissal. I authorize the references and supervisors listed above to give Celestial Club, Inc and all information concerning my previous employment and any pertinent information they may have, person or otherwise and I release all parties from any liability for any damage that may result from furnishing said information. In consideration for employment, I agree to conform to the rules and regulation of the employer and that my employment and compensation can be terminated at anytime, with or without cause, at the option of either the company or myself.

Signature (Name): , Date:

1. Have you ever been convicted of a crime or been found to have committed a crime and had adjudication of guilt withheld by a judge?

2. If the answer to question number 1 is yes, provide details concerning the conviction(s) or withholding of adjudication, including:
a. Offenses for which you were charged
b. Date of disposition of the charge (generally referred to as "sentencing")
c. County and state where the case was disposed
d. Penalty imposed by the Court in the case

3. Have you ever been the Defendant in a civil action for an intentional tort (including but not limited to assault, batter, theft)?

4. If the answer to question number 3 is yes, provide details concerning the legal action, including:
a. The nature of the allegation against you in the civil action
b. The name of the person(s) instituting the lawsuit
c. The approximate date the civil action was instituted
d. The county and state where the civil action was instituted
e. The disposition of the civil action (i.e., the result)

5. Identify all former employers by name, address, telephone number and date of employment. Also indicate why your employment with each former employer was ended (e.g., school, better job, fired, etc.).

6. List at least three (3) persons who can act as references concerning your suitability for employment. Please list name(s), addresses and telephone numbers.

7. By signing below you authorize Celestial Club, Inc. d/b/a Tabu to obtain a check of your driver's license and a criminal background investigation as provided for in Fla. Stat. 768.06.

Signature / Name: Date:

By submitting this online application you also acknowledge that you are being added to Tabu's email list which will provide you with information on our up and coming events.