AMERICAN RETAIL SERVICE LLC.

APPLICATION FOR
LAST NAME
FIRST NAME
MI

EMPLOYMENT
SOCIAL SECURITY NUMBER

..}

PERSONAL INFORMATION
DATE

PERMANENTADDRESS

CITY

STATE

ztP

TELEPHONE

()
ARE YOU LESS THAN 18 YEARS OF AGE?

YES_

NO_

CAN YOU FURNISH PROOF OF THE LEGAL RIGHT TO WORK IN THE UNITED STATES? YES NO

OTHER NAMES UNDER WHICH YOU HAVE BEEN
EMPLOYED:

NAMES OF FRIENDS OR RELATIVES EMPLOYED BY AMERICAN RETAIL SERVICES, LLG.:

HAVE YOU APPLIED TO AMERICAN RETAIL SERVICES, LLC. BEFORE? YES DATE AND POSITION

NO_

HAVE YOU EVER BEEN EMPLOYED BY AMERICAN RETAIL SERVICES, LLC.? YES DATES OF EMPLOYMENT

-

DO YOU HAVE ANY FAMILY, BUSINESS, SOCIAL RESTRICTIONS OR OBLIGATIONS THAT WOULD PREVENT YOU FROM WORKING:

OVERTIME:YES NO

WORKINGCONSISTENTLY:YES

NO

HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR OR FELONY? lF YES, LIST DATES, OFFENSES AND DTSPOSIT|ON (CONVTCTTONS ARE NOT AN AUTOMATTC D|SQUAL|F|CAT|ON FROM EMPLOYMENT, HOWEVER, FAILURE TO LIST WLL DISQUALIFY YOU):

YES

NO

wlLL YOU COMPLY wlTH THE SAFEW, WORK AND ATTENDANCE POLICIES OF OUR COMPANY?

YES_

NO_

EMPLOYMENT INTERESTS
POSITION DESIRED OR AREA OF INTEREST: SECOND GHOICE: UA I E

AVAIUbLE:

TYPE OF EMPLOYMENT YOU ARE SEEKING:

SHIFTS YOU CAN WORK: SUMMER ANY AVAILABLE DAY

SALARY EXPECTED:
NIGHT ANY

FULL TIME

PART TIME

TEMPOMRY

SWNG

HOW WERE YOU REFERRED TO OUR COMPANY? AD OTHER COMPANY AGENCY

-

-

-

-

-

-

-

NAME OF REFERRAL SOURCE:

-

-

EMPLOYEE SCHOOL SELF

-

-

-

EMPLOYMENT SERVICE OTHER

MAJOR
UNITS GOMPLETED AND GPA DEGREES/DIPL.

EDUCATION/MI LITARY SERVICE
scHooL oR
INSTITUTION' HIGH SCHOOL NAME AND ADDRESS OF SCHOOL

COLLEGE

OTHER

HONORS OR AWARDS RECEIVED;

HELD:

ARE YOU TAKING ANY COURSES PRESENTLY? YES WHERE; NO

INDICATE FOREIGN LANGUAGES THAT YOU:

PRESENT COMMUNIfi AND PROFESSIONAL AFFILIATIONS (EXCLUDE AFFILIAT'ONS WHICH MIGHT INDICATE RACE, RELIGION, AGE, SEXUAL ORIENTATION OR NATIONAL ORIGIN):

-

SPEAK-READ-WRITE
HAVE YOU EVER SERVED IN THE ARMED FORCES? MILITARY DUTIES AND SPECIAL TRAINING: RANK AT DISCHARGE

YES_NO_

REFERENGES
NAME
LIST PEOPLE WE MAY CONTACT WHO ARE QUALIFIED TO EVALUATE YOUR CAPABILITIES (DO NOT INCLUDE RELATIVES}

ADDRESS

CITY

STATE

z:IP

TELEPHONE (MUST BE CURRENT} INCLIJDE AREA CODE

OCCUPATION

YEARS KNOWN

sNv€ EfiFLSYI6EilT HIST SRY AS COi,tPt-€TELy AS POSS|BLE reR 4 f/{,{/ffir.Fl OR SELF€iIPLOYES PER}o$g AND NI,IA€ATE D/rTES AJ*D CfififfifrTffi;

EMPLOYMENT }IISTORY
I

l\ror

LIST CURREMT ON ilOST RECE T €NFLOYERhR$T. 5H8I,'U'{€SFLOYE'} *NgL{J8E P&FTTITIE OR AUBMTR WOEK YOt' I'TYUgFADIX?IOHALSFEfg lrI{€CEssARY

APER€55

IELfrFH0I'If

Dj,TES Efidpt-&vt$ €*{:}rirl?{/f FROIT: aA,sE PAY {HR lY€SKtJiro.i
TO:

HAil

(l
JOB 1T'!.E
SUFERVI.S0R"S ttlA#gTtTLE

TYPSOF ArS*!'ts$S

$TAfiT:
DESCRIFTIOiI GF DUTIES: REASO'{ ISR LEAVTH6:

...

..

* lEftD.*.--..*_
6$pt

MAYWE COrftArT ThrS

YES

rlo

{CURRENTOR

LA$q

r6}aEEs9

TELEPHSWE

aATES EMPLOYE {$S}rTtllYEa.F} FROiil:
YO:

at
JOg fiYL{

suPc*vrsofis

NnsrE TITLE

?vp€ t,$

6{.J*.$.?*Es

6&5e PAY {flRiffEEfi"no-l

STTR?:
D€SCR|FTISI$

T€ND

Sf *ufi€g;

R**5OH F*&,Lf;AVI}J€:

lr

Y lry€

c0tirAcr Ttltg Hirft-gYgfl?

Y€S_ NO_
coMPrNY fiAlr€ {cdRnEflT o& t"4$T1
APOR€SB

Tf;LSp8$r$g

g& T€S FR6II:

E|iITPLOYEO

{ilrt$NTf i/YEAR} TO:

(t
JOBTnLE
S{JFE}AV$S,f S tlttltt€llYrLE TYF6 QF 6U*ATIF6g

E*Ss flAY

{t"{s1qFdgEl.Vrirg"}

START:
qESCRIfTKXT{CF 'JU?IFS: REASO!{ fQG t-E*1fiH6:

/END'-_

$JIYWE COlIfA,aT THIS eilFL0YEn?

Yes-* Fo_
i hereby affim that the irrfonnation provided on this empbymefi applicatjon form and on rny resurne is true and complete to the bEst of my knowfedge. I understaild and agre€ that fulslfied infonT-ratian or ornissionc rnay rexrtt in lermination ?om employment if
discovered after my employment has begun.

ACKNOWLEDGMENT {PLEASE READ CAREFULLY BEFORE StcNtNG BELOW}

I hereby authorize American Retait Services, LLC., (hereinafter refened to as the Company) to substantiate and verify my pact emptoyrnent" previouo salary histcry, ercderrtial$, and any olher in{ormathn assoeiated with *y qrialifications. I also authorizb my previouq $chool$, ernployers" arrd listed references to release to the Company any relevant informatian {frat may be requested in connection wilh my employment. I agree ttrat the Company and iny previous employers, schoofs and referenceg sh€ll not be held lia-ble if any employment offers are not tendered or withdrawn. or if nry employment is terminated due to falsity or omissions in the
screening test. I conse$t to sny testing n€cessary to determine the presence and/or level of drugs and alcohol in my body other than drugs prescribed by a phyeic.ian- This atso indudes, b{.* is nqt limtted b, mndcrn tesfing of me as an employee it t an'l in a safety sensitive positirrn as defined by oornpany Foli6y. ln addition, if rea*onable eause ls suspecteO cr I am invoheC in a work+elated accident or injury, I consent to submil to a drug and alcohol screening. .. I fu{her agree to wear or ute, wtr€n F"$c{ib€d by the Company, safety equipnrent or prote{.th/e devices and to comply wrth all health.and safety nrles and rcporfng requirernents- I agrbe to abide S-trre adriiniitrb$ve ruleE of csnduct pf the Company. ' ' I underetand that no s*alement irr thia forrn, related policie$, or any ofier of ernployment is to be oonstrued as an employmenl contra{t, and th* eithsrparty, without the othefs consent, may terminate ihe emgoymenlrelationship at any time for any reas*| witfi or withoul cause or nslice. Any agreemenf rnlfNieh varies the right of the empliye-* or tFre Company to terminate the erflployment relationship al any time, with or without cause or notie- must be set forth in'an express wrifien-agreement and signed Uy Uottr tire employee and the company president. I u*derstand that nny application for employrnefit vrill be ptaced in an active status for a period of g0 days during which time it will be reviewed as job openings occur in my.area(s) of job interest. t underctand thai*le C**p*oy sny or rnay oo{ contact me oR the status of lry application |as?d on.rny quilifications ind available opqnings and I shoutd i"sirme that mf applicauon has been revierryed- I f*rtfter t-tnderstand fftat if I wish my appfication to remain a*ive {er a peri,od longer than g0 days" I rnust comptete a new
application.

inbmratian I have prpvidod" t understand and agree that any employment offer I migltt mceive rnay be contingent upon my paesing a drug and alcotrol

DATE:

SIGNATURE:

AP

PLrcANr Qg ESTnN

NA!.!RH
_ --i

]

Have

yCIu

worked in a retail servlces environment in the past? lf so, explain your experience?

"

ln your past employment, have you ever been responsible for money or cash a$ part of your job description? lf so, please explain responsibilities.

.

Why are you seeking employment at this time?

"

If hired, would you have reliable transpofiation tg work?

"

When are you available to begin working?

"

How did you hear about our Company?

r

Are you availabfe to wcrk all 7 days of the week {i.e. weekends and holidays}?

'

Are you available to work any shifi (i.e" day, swing and graveyard)? Overtir-ne?