EMPLOYMENT APPLICATION

                                                We are an Equal Employment Opportunity Employer

Social Security Number __ __ __ - __ __ - __ __ __ __ __                        Date __________

Name ___________________________________________________________________

Home Phone (___) __ __ __ - __ __ __ __    Message Phone (___) __ __ __ - __ __ __ __

Current Address __________________________________________________________

           City      __________________________   State __________  Zip ___________

Position applying for ______________________Date Available to Start ___________

Are you 18 or older?  Yes ___  No ___ Type of work seeking:  Full time ___  Part time ___

What are your hours of availability? __________________________________________

Highest Level Of Education Completed ___________________

Have you ever been terminated from any job for any reason? Yes ___  No ___

Trade/Business School or College Attended            Degree or Certificate        Dates Attended

Name

City/State/Zip______________________________________________________________

Do you have friends or relatives currently employed by us?   Yes ___  No ___

If yes, who and where _______________________________________________________

Have you been employed by this company before?  Yes ___ No ___

If yes, when and where _________________________  Reason for leaving: ____________

Have you ever been convicted of any crime other than minor traffic violations? Yes ___No__

A conviction may not necessarily disqualify you.  Do not list convictions where the record has been expunged or

sealed, or misdemeanor convictions which have been dismissed upon completion of probation.  If yes, when, where

and what was the disposition of the case?

___________________________________________________________________________________________________

Are you currently under arrest for any crime for which you are now out on bail or on your own recognizance

pending trial?

Yes ___ No___  If yes, please explain ______________

Have you ever quit a job after being notified that you would be terminated?  Yes ___ No___

If your answers to either of these questions is “Yes”, please explain.  (List the employer’s name and address,

including zip code and dates)___________________________________

________________________________________________________________________________________________

List all jobs, self-employment and military service beginning with the present and going back for 5 years.

May we contact your present employer?  Yes ___ No___

FROM    TO     EMPLOYERS NAME               PAY     POSITION & TYPE            SPECIFIC REASON

MO/YR   M/Y         AND PHONE NUMBER             RATE     OF WORK PERFORMED      FOR LEAVING

 Immediate Supervisor:

___________Phone (   )______________________________________________________________________

                         Immediate Supervisor:

___________Phone (   )______________________________________________________________________

                         Immediate Supervisor:

___________Phone (   )______________________________________________________________________

                         Immediate Supervisor:

___________Phone (   )______________________________________________________________________

                         Immediate Supervisor:

___________Phone (   )______________________________________________________________________

Please explain reason for any periods of unemployment between jobs:

In case of an emergency, notify:

I hereby certify that the information set forth in this application is true and complete.  I understand that any omission,

falsification, or misrepresentation of fact in the application will entitle the company to terminate my application for

employment or terminate my employment regardless of when discovered. I hereby authorize the company to conduct

an investigation of my background to include contacting previous employers. I hereby authorize all personnel, schools,

companies, corporations and law enforcement agencies to supply any and all information relating to my qualifications

for the position applied for and I release the same from any liability resulting from providing such information. Any

offer of employment may be contingent upon my passing a drug screen and/or a post-offer medical examination.  I

understand and agree that if I am employed, my employment is for no definite or determinable period and may be

terminated at any time, with or without cause of prior notice, at the option of either myself or the company, and that

no contrary promises or representations are binding on the company unless made in writing and signed by the President

of the company. Similarly, I understand and agree that the company has the sole discretion to make employment

decisions including, but not limited to, promotions, demotions, transfers, discipline and the assignment of work.

If hired, I understand the law requires that I provide proof of identity and eligibility to work in the United States.

 This application will be given due consideration, but its receipt does not imply that I will be employed.

______________________________________                                              _______________________

Signature of Applicant                                                                             Date

(The following is completed by store director)

_________________________   ___________       __________________    _________________

Position                                         Salary                  Actual Start Date             Store Location

__________________________________________Store Director