Appearance Group

APPLICATION FOR EMPLOYMENT

IT IS OUR POLICY TO COMPLY WITH ALL APPLICABLE LOCAL, STATE AND FEDERAL LAWS PROHIBITING DISCRIMINATION IN EMPLOYMENT BASED ON RACE, RELIGION, COLOR, SEX, AGE, NATIONAL ORIGIN, DISABILITY, MILITARY STATUS OR OTHER PROTECTED CLASSIFICATION.

Name Date:

Street Address Social Security No.

City State Zip

Home Tel. No Business Tel. No.

May we call you at your business number? Yes No

Email Address

1. TYPE OF WORK DESIRED

Indicate the position for which you are applying:

Do you wish to work: full-time; part-time; temporarily?

If part-time, please specify hours or days:

Are there any hours, shifts, or days you cannot or will not work? Yes No

If yes, when?

Are you able to meet the attendance requirements of the position? Yes No

Are you willing to work overtime as required? Yes No

What is your minimum hourly or weekly salary requirement?

Date available for work:

Do you have any commitments to another employer that might affect your employment with us?

2. SKILLS

Summarize any training, skills, licenses and / or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying:

III. EMPLOYMENT HISTORY

(Note: Your application will not be considered unless every question in this section is answered. Since we make every effort to contact previous employers, the correct telephone number of past employers is critical. Ask for a phone book or call information if you need.)

List present employer or most recent employer first (use other side of this application, if necessary). If you are currently employed, may we contact that employer? Yes No

MOST RECENT EMPLOYER

SECOND MOST RECENT EMPLOYER

THIRD MOST RECENT EMPLOYER

4. EDUCATIONAL DATA

5. GENERAL INFORMATION

Are you legally authorized to work in the United States? Yes No

Are you below the age of 18? Yes No

Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by
an employer covered by DOT agency drug and alcohol testing rules during the past two years? Yes No

In the past two years, have you been employed with an employer covered by DOT agency drug
and alcohol testing rules? Yes No

Have you ever plead "guilty" or "no contest" to, or been convicted of a criminal offense? Date

City, State Nature:

(Note: An affirmative answer will not automatically disqualify you from being considered as a candidate for employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.)

Have you previously applied for employment here? Yes No

If yes, when?

Have you previously been employed by this company? Yes No

If yes, when?

Drivers license number if driving is an essential job function. State

References

(Note: Include only individuals familiar with your work ability. Do not include relatives.)

Please include any other information you think would be helpful to us in considering you for employment, such as additional work experience, special interest, activities, accomplishments, etc.

6. REPRESENTATIONS

Please read the following carefully before signing this application form:

I certify that all information I have provided in order to apply for and secure employment with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from any and all references (personal and professional), former employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, and I release the employer and such other entities and individuals from any liability for any damages whatsoever that may result from their so doing. I also authorize all references (personal and professional), former employers, public agencies, licensing authorities and educational institutions to release any and all information concerning my background, previous employment, education or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from any liability for any damages whatsoever that may result from their furnishing such information.

I understand that this application remains current for only 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am employed, I understand that my employment will be at-will, and the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid.

I understand that after an offer of employment, and prior to reporting to work, I may be required to submit to a medical review. Depending on company policy and the needs of the assigned job, I may be required to complete a medical history form and may be required to be examined by a medical professional designated by the employer.

I also understand that the illegal use of drugs is prohibited during employment. As company policy provides, I may be required to submit to drug testing to detect the illegal use of drugs prior to and during employment.

(Date)