EMPLOYMENT APPLICATION: Introduction

This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract.

Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment.

All qualified applicants will receive consideration without discrimination based on sex, marital status, race, color, age, creed, national origin, sexual orientation, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities.

A conviction will not necessarily bar an applicant from employment.

Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment.

After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

Your Information

POSITION APPLIED FOR: STORE APPLIED FOR:

TODAY'S DATE:

NAME (F/M/L)

SOCIAL SECURITY NUMBER

HOME / CONTACT PHONE:

WORK PHONE:

Current Address:

STREET:

CITY - STATE - ZIP

Prior Address:

STREET:

CITY - STATE - ZIP

AVAILABILITY

What date can you start?

What Category would you like?

Full Time

Part Time

Temporary

Labor Pool

For which schedules are you available?
Reasonable efforts will be made to accommodate sincerely held religious beliefs and practices.

Weekdays

Weekends

Evenings

Night

Overtime

Shift

Other

JOB-RELATED SKILLS

NOTE: Do not fill out any part of this section that you believe to be non-job related.

If the job requires, do you have the appropriate valid driver's license?

Name on license

DL#

TYPE

State of Issue

Please list any moving violations within the last 7 years

Please list any other skills, licenses or certificates that may be job-related or that you feel would be of value to this job or company.

Have you been given a job description or had the essential functions of the job explained to you?

Yes

Do you understand these essential functions?

Yes

Can you perform the essential functions of this job with or without reasonable accommodation

Yes

SECURITY

List states and counties of residence for the past seven years

Have you used any names or Social Security Numbers other than given above? If so, please list in comments, below.

Yes

Have you been convicted of a crime in the past seven years? If so, please describe in the boxes below. Applicant is not obligated to disclose any reference to a pre or post trial diversion program, any conviction which has been sealed, expunged or erased by the court, or, if in California, any marijuana related misdemeanor conviction entered more than two years prior to the date of this employment application. (Conviction will not necessarily be a bar to employment. In accordance with company policy and applicable state and federal laws, factors such as age at time of the offense, remoteness of the offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed.)

INCIDENT CITY/STATE CHARGE

Additional Comments About This Section

PREVIOUS EMPLOYERS 1of 3

Phone Fax

Company Name

City State

From To Job Title Supervisor Name

Duties

Salary (Dollars pre Hour,Week,Month)

Reason For Leaving

Additional Comments about this employer

PLEASE NOTE: Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. Ask for a phone book or call information if necessary. FOR EMPLOYERS OUTSIDE THE U.S., A CURRENT FAX NUMBER IS MANDATORY.

Most Recent Employer

Yes

Are you currently working for this employer?

Yes

If yes, may we contact?

PREVIOUS EMPLOYERS 2of 3

Second Most Recent Employer

Click here ONLY if you have not had a 2nd most recent employer

Phone Fax

Company Name

City State

From To Job Title Supervisor Name

Duties

Salary (Dollars pre Hour,Week,Month)

Reason For Leaving

Additional Comments about this employer

PREVIOUS EMPLOYERS 3of 3

Third Most Recent Employer

Click here ONLY if you have not had a 3rd most recent employer

Phone Fax

Company Name

City State

From To Job Title Supervisor Name

Duties

Salary (Dollars pre Hour,Week,Month)

Reason For Leaving

Additional Comments about this employer

REFERENCES

Include only individuals familiar with your work ability. Do not include relatives or names of supervisors listed from PREVIOUS EMPLOYERS section.

NAME #1

ADDRESS PHONE

YEARS KNOWN/RELATIONSHIP

NAME #2

ADDRESS PHONE

YEARS KNOWN/RELATIONSHIP

EDUCATION

NOTE: Do not fill out any part of this section you believe to be non-job related.

If your school records are under a different name than listed on page 1,
please enter that name here.

HIGH SCHOOL NAME CITY/STATE

GRADUATED
_______________________________________________________________

COLLEGE NAME CITY/STATE

GRADUATED

DEGREE TYPE

_______________________________________________________________

OTHER SCHOOL NAME CITY/STATE

GRADUATED

DEGREE TYPE

Yes

CERTIFICATION

I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief.

I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment.

I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information.

I release all former employers, persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information.

I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

________________________________________________________________________

I Have read and understand the

above information, and am I submitting this electric form as a application to work for
Disabled American Veterans Thrift Stores of Missouri.