Pattern Equal Employment Opportunity This request to consider yourself to be completely filled Name or Physical Mailing Address Name

Initial Social Security Number City, State and Zip Code Yes No Location () Telephone No. () Alternate Phone No. Have you worked with Wal-Mart or any of its subsidiaries? Date of Employment Reason for leaving Name at time of employment Position applied for Desired Income Date available to start List relatives who work for Wal-Mart, their relationship and where you work (if you live in California, do not answer) Seeking employment. Are you over 18 years of age? Yes No Note: Employment part is less than 32 hours per week. After being hired, can you submit legal verification of their right to work in the U.S.? Part Time Full Time Temporary Employment In under 18 are required birth certificate or a work permit as required by feder al and state law. Elementary School or less Yes Not Mark the level of studies completed or the equivalent completed: "Technical college or studying? Yes No 8 9

October 1911 12 1 2 3 4 Name of school, college or voc-technical where he studied EMPLOYMENT HISTORY-The following details your current job. If you are or are unemployed or pecify the dates and location. (If necessary, Company Name Address City / State / Zip Phone Income per hour Reason for leaving job employment history, start with the have been employed on their own, s include additional sheets.) # Position: Supervisor: From: To:

Company Name Address City / State / Zip Phone # Position: Supervisor: From: To: Income per hour Reason for leaving job Company Name Address City / State / Zip Phone # Position: Supervisor: From: To: Income per hour Reason for leaving job â ¢ To be employed this would allow us to communicate with your employer? Yes No In Washington, list only convictions that have occurred within the last seven ye ars and convictions for which he was acquitted of the prison within the last sev en years. In Hawaii, do not answer the following questions. AVAILABILITY - Please help us consider you for the role that is consistent with their availability, please let us know the earliest time and later you can work every day. Day Sunday Monday Tuesday Wednesday Thursday Friday Saturday Collate if available to work: â ¢ â ¢ Have you ever been convicted of a felony? Yes No Have you ever been convicted of any type of theft, fraud or violent crime? Yes No Time + early Time + later If your answer is Yes, in a separate sheet, identify the crime for which he was convicted, the date of conviction and the location of the court in which he was convicted. Please provide any details you consider relevant. The conviction of a

crime does not automatically disables consideracón employment, but will be con sidered in the overall assessment of their qualifications. Name two (2) persons (not related) with whom you have worked and that we can use as references if needed. Name: Occupation: Phone #: Address: City: Name: Occupa tion: Phone #: Address: City: State: State: Days Afternoons Nights Saturday Sunday IMPORTANT - We are glad you are interested in (a) to be part of our family Wal-M art. Please read the following statements carefully before signing and returning the application. In considering my application for employment, the Company may verify the informa tion in this application and obtain additional information concerning my history . I authorize any person, school, companies, corporations, credit bureaus, agenc ies approve practicing law information related to my history I have read, unders tand and agree with this statement. (Please start here) I understand that Wal-Ma rt Stores, Inc. is committed to keeping the workplace free of alcohol and drugs, and unless prohibited by state law, Wal-Mart requires drug test as part of the process of selection and recruitment. I understand that such drug testing is a u rine analysis and / or several other recognized medical tests designed to detect specified quantities of controlled substances in my body. To find any detectabl e amount in my body will provide a second test approved by NIDA on the same spec imen. If the second test proves positive, I will be disqualified from any consid eration for employment and / or any offer of employment will be revoked. I also understand and agree that if employed,€under any circumstances during my employ ment may be referred to take proof of alcohol and drugs. I have read, understand and agree with the above in this statement, (please start here) I certify that all information provided in this application is correct and understand that any misrepresentation or omission of any information will result in disqualification of any consideration for employment or if hired, my dismissal mean. I understan d that this application is not a contract, offer or promise of employment and to be recruited will have the right to resign at any time for any reason. I also u nderstand that no one except the President of Wal-Mart Stores, Inc. and / or Vic e Chairman of the Division of Personnel has the authority to enter into contract or employment agreement with me. I have read, understand and agree as set forth in this statement. (Please INCIE here) I understand that this application is valid for sixty (60) days of the date here of. If you still want a position with the Company after the expiration date of t he application, it is my responsibility to complete a new application. Otherwise , I will not be considered (a) after the expiration date. Date of Application Signature as shown on Social Security Card