Employment Application Applicant Information Date: First Name: Middle Initial: Last Name: Street Address: City: State: Zip Code: Phone Number: E-Mail: Date Available: Position Applied For: Store Choice: Strip DistrictBeaverMiamisburgMiddletownChillicotheMt LebanonTroyStroudsburgCuyahoga FallsBethlehem What is your Availability?: Are you legally eligible to work in the US?: YesNo Have you ever worked for this company before?: YesNo Have you ever been convicted of a felony?: NoYes Education Highest Level Completed: City, State: When: Did you graduate?: YesNo Employment History Most Recent Employer: From: To: City, State: Phone Number: Supervisor: Responsibilities: Reason for Leaving: May we contact?: YesNo Disclaimer and Signature I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me. I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself.