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Biglots App LWA

Biglots App LWA

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Published by L Adams
Filled out PDF Big Lots application, using sign tool in adobe acrobat (free version)
Filled out PDF Big Lots application, using sign tool in adobe acrobat (free version)

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Published by: L Adams on Aug 28, 2013
Copyright:Attribution Non-commercial

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08/28/2013

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Name (Last, First, Middle) Contact Phone NumberStreet AddressCity State Zip E-mail AddressPosition(s) interested in?Salary Requirements Are you under the age o 18? Yes NoHour/Year (Circle One) I yes, state your age.Have you ever worked or Big Lots beore? Yes NoI yes, when and where?I hired, can you supply proo that you are legally entitled to work in the United States or any employer? Yes NoDo you have riends or relatives working or us? Yes NoI so, who?Can you work: Anytime Days Evenings WeekendsAre there any times or days you cannot work?Have you ever been convicted o (1) a violent crime (i.e., assault, battery, murder, etc.), (2) a retail related crime (i.e., shopliting, credit card raud,robbery, thet, burglary, etc.), or (3) drug trafcking/distribution? Yes No
Note: A “yes” response will not automatically disqualiy you rom employment, but will be considered as part o your overall job-related qualifcations or employment. You donot need to disclose any inormation regarding arrests or any criminal charges and/or convictions that have been erased, annulled, sealed and/or expunged rom your record.
I yes, please describe:
 
Please also provide any other inormation you would like the Company to consider about the conviction including but not limited to: the time that has elapsed since the oense, your age at the time o the oense, acts or circumstances surrounding the oense, the number o oenses or which you have been convicted, your employment history beoreand ater conviction, evidence o rehabilitation, and/or other mitigating actors. Enter N/A i you answered No and this question does not apply to you. Please use additionalpages i necessary to answer this question.
BIG LOTS EMPLOYMENT APPLICATION
This application is considered activeor ninety (90) days.
DRUG-FREE WORKPLACEAll employees are subject to drug and alcohol testingprocedures permitted under ederal and state law.
WOTC Registration #
PERSONAL DATA
Please complete in ink.
REFERENCES
List names o three people (other than relatives) we may contact who have knowledge o your job-related skills.Name Telephone Contact/E-mail Contact Address/City/State Occupation
123
AN EQUAL OPPORTUNITY EMPLOYERBig Lots is an Equal Opportunity Employer and does not discriminate in making employment decisions based upon race,color, sex, religion, national origin, age, disability, marital status, sexual orientation, or veteran or military status.
SOS SKU# 960600043 • 05/13
EDUCATION
Type o School Name o School Location o School Area o StudyLast Year Did You Earn aCompleted Degree or Diploma?High School 1 2 3 4 Yes NoCollege 1 2 3 4 Yes NoGraduate 1 2 3 4 Yes NoOther 1 2 3 4 Yes No
CONTINUED ON BACK 
Adams, Leslie, W919-413-99991291 - D Schaub DrRaleighNC27606leslieadamsnc@gmail.comStock or cashier$7.00 ___ xxxxxxx
N/A - I do have a felony on my record that has been expunged but may still be visible to in depthsearches.
Douglas ByrdFayetteville, NCH.S. subjectsxSchenck Job CorpsPisgah Forest, NCGEDx
Betty Connette
X919) 859-03496212 Oak Stand Cir Raleigh, NC 27606MinisterSusan Cummings919) 467-3338107 Dabney Rd Cary, NC 27511Loretta Allen-Adams919) 847-90936304 Rushingbrook DriveRaleigh, NC 27612Ret. TeacherRed Cross Vol.
 
EMPLOYMENT HISTORY 
BEGINNING WITH YOUR MOST RECENT EMPLOYER, LIST ALL EMPLOYMENT INCLUDING MILITARY SERVICE AND SELF-EMPLOYMENT. Please accountor all periods o unemployment. All sections o this application must be complete even i a resume is attached.
If presently employed, may we contact your employer for references? Yes No May we contact you at your place of employment? Yes No
I understand that Big Lots may contact the past employers and/or personal reerences I have provided in order to veriy my past employment andwork record. I authorize all past employers, educational institutions, government agencies and/or personal reerences to release any and all inormationconcerning my past employment work history, perormance, and personal character. I hereby release all such employers, personal reerences, and BigLots rom any and all liability resulting rom damages I may incur in the reerence verifcation process. I understand that my employment or continuedemployment is contingent upon my successully completing both reerence and background checks.I also understand that i employed by Big Lots, my employment is “at will” and can be terminated at any time or any reason either by mysel or theCompany. This agreement cannot be modifed by any representative o the Company either in writing or verbally.Finally, I understand it is unlawul or Big Lots to employ anyone who is neither a citizen o the U.S. nor an alien authorized to work in the U.S. I certiythat any U.S. citizenship/work authorization inormation I provide to the Company is authentic. Further, I certiy that all inormation I have provided on thisapplication is accurate.False inormation or omission o acts on this application may result in the termination o my employment with Big Lots.Applicant’s Signature DateThank you or your interest and the time you have taken to submit this application.Name o present or last employerAddressCity, State, ZIPPhone Number ( ) Job Title/ResponsibilitiesWas your position Full time Part time
Reason or leaving Terminated Voluntary InvoluntaryExplain
From (Mo. & Yr.) To (Mo. & Yr.)
Supervisor NameStarting Salary $Last Salary $Name o previous employerAddressCity, State, ZIPPhone Number ( )Name o previous employerAddressCity, State, ZIPPhone Number ( )Name o previous employerAddressCity, State, ZIPPhone Number ( )Name o previous employerAddressCity, State, ZIPPhone Number ( )
From (Mo. & Yr.) To (Mo. & Yr.)
Supervisor NameStarting Salary $Last Salary $
From (Mo. & Yr.) To (Mo. & Yr.)
Supervisor NameStarting Salary $Last Salary $
From (Mo. & Yr.) To (Mo. & Yr.)
Supervisor NameStarting Salary $Last Salary $
From (Mo. & Yr.) To (Mo. & Yr.)
Supervisor NameStarting Salary $Last Salary $ Job Title/ResponsibilitiesWas your position Full time Part time
Reason or leaving Terminated Voluntary InvoluntaryExplain
 Job Title/ResponsibilitiesWas your position Full time Part time
Reason or leaving Terminated Voluntary InvoluntaryExplain
 Job Title/ResponsibilitiesWas your position Full time Part time
Reason or leaving Terminated Voluntary InvoluntaryExplain
 Job Title/ResponsibilitiesWas your position Full time Part time
Reason or leaving Terminated Voluntary InvoluntaryExplain
I have had no W-2 employment for 10 yearsI was a caregiver for the last 4 for my roommateWho was ill and needed taking care of while Hospicewas not available8/27/2013
 
Leslie Wayne Adams244-39-48331291-D Schaub DrRaleigh, NC 27606Wake919) 413-99998/27/2013

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