| Store | Fixture | Installation | Retail

Application

	Applicant Personal Information
	First Name:
	Last Name:
	Middle Initial:
	Street Address:
	Apartment or Unit #:
	City:
	State / Province:
	Zip / Postal Code:


	Cell Phone:
	Home Phone:
	Email Address:


	Date Available:


	Applying for position of: (select both if applicable)	Fixture Installer Graphics Installer Team Lead


	Are you a US citizen ?	Yes No
	If No, are you authorized to work in the US ?	Yes No
	Have you ever worked for this company before	Yes No
	If yes, when ?
	Are you willing to travel ?	Yes No
	If "yes":	Occasionally Road Warrior
	How did you hear about us ?
	If Referral, please specify:

	Education
	Did you graduate or have a G.E.D. equivalent ?:	Yes No

	Previous Employment History
	Do you have experience in the retail industry?:	Yes No
	If "yes", please select all that apply:	Signage installation Fixture Installation General Merchandising Other (Please specify)
	Previous Employer:
	Start Date:
	End Date:
	Reason for leaving:
	Please list any additional skills or trades:

	Certifications & Skills

	Have a valid driver’s license ?:	Yes No
	Have reliable transportation ?:	Yes No
	Able to work overnight shift ?:	Yes No
	Able to lift 50 lbs ?:	Yes No
	Able to climb ladder ?:	Yes No
	Able to supply own tools ?:	Yes No
	OSHA certified forklift driver ?:	Yes No
	OSHA certified scissor lift operator ?:	Yes No

	References - (Please list three professional references)

	Full Name:
	Company:
	Address:
	Best Phone #:
	Relationship:


	Full Name:
	Company:
	Address:
	Best Phone #:
	Relationship:


	Full Name:
	Company:
	Address:
	Best Phone #:
	Relationship:

	Disclaimer & Electronic Signature
	I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
	I agree: