EmploymentApplication

Thankyouforapplyingto99OnlyStores
Wheretheopportunitiesaregoldenandthepossibilitiesendless!

99OnlyStoresisanequalopportunityemployerbybothpolicyandpracticeandsubscribestofederalandstatelawswhichforbiddiscrimination
becauseofrace,color,religion,age,sex,nationalorigin,maritalstatus,disability,oranyotherlegallyprotectedstatus.
Kindlyfillouttheapplicationcompletelyandgiveittothereceptionistorthestoremanager.Incompleteapplicationscannotbeaccepted.

(pleaseprint)

PERSONALINFORMATION

___________________________________ __________________________ __________________________

(______)_________________

_________

LastName

FirstName
SocialSecurityNumber

PhoneNumber

Date

Ifunder18yearsofage,canyouprovideproofofyourabilitytowork?
YesNoNA
AreyoulegallyeligibleforemploymentintheUS?
YesNo

Haveyoueverbeenconvictedofacrimeotherthanaminortrafficviolation(Pleasenotethatinansweringthisquestion,99OnlyStoresdoes

notrequest,andyoushouldnotprovide,anyinformationconcerninganyarrestordetentionthatdidnotresultinaconviction,anyreferralto
Referredby:

orparticipationinanydiversionprograms,oranyconvictionfromtwoyearsagoorearlierforamarijuanarelatedoffensethatdidnot

____Person_______________
involvethesellingofmarijuana.)?
YesNoIfYes,pleasebelow.

____Newspaper____________

____Walkin_______________

________________________________________________________________
__________________________________________________________________

____Other________________

PresentAddress

City
State
ZipCode
PreviousAddress

City
State
ZipCode

(Ifapplyingforaretailhourlyposition,pleasenotethatavailabilityofhoursmayvaryandarethusnot

guaranteed)

Doyouhavefriends/relativesworkingat99OnlyStores?Yes_________________No

Position______________________ExpectedWage$______perhourDateAvailable___________
Haveyoueverworkedfor99OnlyStores?YesNo

Applyingfor:
Fulltime ParttimeTemporary

Ifso,when______________where___________________

Sunday
Monday

Tuesday
Wednesday
Thursday

Friday
Saturday

Isthereanyreasonwhyyouwouldnotbeabletoperformallofthejobdutiesofthepositionyouhaveappliedfor?YesNo

IfYes,pleaseexplain________________________________________________________________________

HighSchool

1234

Y
N

College

1234

Y
N

PostCollege

1234

Y
N

Trade,Business

1234

Y
N

School

Haveyouevershoppedat99OnlyStores?Where?Kindlydescribeyourexperience.

_____________________________________________

Whydoyouwanttoworkfor99OnlyStores?________________________________________________________________________________

____________________________________________________________________________________________________________________________

Describeaspecificsituationwhereyouprovidedexcellentcustomerservice.Whywasiteffective?_________________________________

explain_____________________________________________________________________________________________

(Aconvictionisnotanautomaticbartoemployment.Eachcasewillbeconsideredonitsownmerit)

EMPLOYMENTDESIRED

EDUCATION

NameandAddressofSchool

CircleLast

DidYouSubject(s)
YearCompleted Graduate?
Studied

(Pleaselistyourlast3employersbeginningwithyourmostrecent.Pleasecompleteevenifyouattacharesume)

StartDate

Salary/Hourly

Reasonfor

StartingPay/Ending
Position
Duties

Leaving
EndDate CurrentEmployer(Name&Address)

Salary Hourly

Starting$______perhr

Ending$_______perhr

SupervisorsName_____________________________PhoneNumber_________________________
MayWeContact?YN

PREVIOUSEMPLOYMENT

StartDate

Salary/Hourly

StartingPay/Ending
Position
EndDate CurrentEmployer(Name&Address)

Salary Hourly

Starting$______perhr

Ending$_______perhr

SupervisorsName_____________________________PhoneNumber_________________________

PREVIOUSEMPLOYMENT

StartDate

Salary/Hourly

StartingPay/Ending
Position
EndDate CurrentEmployer(Name&Address)

Salary Hourly

Starting$______perhr

Ending$_______perhr

SupervisorsName_____________________________PhoneNumber_________________________

PREVIOUSEMPLOYMENT

Duties

Reasonfor
Leaving

MayWeContact?YN

Duties

Reasonfor
Leaving

MayWeContact?YN

Ifemployedby99OnlyStores,Iagreetoabidebyitspolicies,rulesandregulationsandunderstandthattheymaybechangedatanytime.Iunderstandandagree
thatmyemploymentisatwillandcanbeterminatedwithorwithoutcauseandwithorwithoutnoticeatanytime,attheoptionofeithertheCompanyormyself.I
furtherunderstandandagreethatthisatwillemploymentrelationshipwillremainineffectthroughoutmyemploymentwith99Onlystoresunlessitismodified
byaspecific,expresswrittenemploymentcontractwhichissignedbyitsPresidentandmyself.Thisemploymentrelationshipmaynotbemodifiedbyanyoralor
impliedagreement.IunderstandIwillberequiredtosubmittoanalcoholand/ordrugscreeningataCompanyselectedfacilityattheCompanysexpense.I
understandifIfailthescreening,IwillnotbepermittedtocommenceworkwiththeCompany,orIwillbeterminatedifIhavealreadycommencedworking.I
understandandagreethatanyhandbookwhichImayreceivewillnotconstituteanemploymentcontract,butwillbeastatementoftheCompanyscurrentpolicies.

Iauthorize99OnlyStorestoobtainanyinformationconcerningmefrompreviousemployers,schoolofficials,andothers.Ireleaseallconcernedfromanyliability
inconnectiontherewith.Icertifythatallinformationgivenonthisapplication(includingresumeandotherattachments)iscorrecttothebestofmyknowledge.I
understandthatanywillfulomission,falsificationormisrepresentationmayconstitutegroundsfortermination.Iunderstandthisapplicationisgoodforonlythirty
(30)days.Acopyofthisapplicationwillbefurnisheduponrequest.
Forretailpositions,pleasesubmitthis

applicationatneareststorelocation.
________________________________________________________________
________________________
Signature

Date

OFFICEUSEONLY:HireforPositionof:______________________________________Store/Department:_____________________________PermitNeeded:YN

SignatureofInterview:__________________________________________________________Date:_________________________

EOErev.7/03