APPLICATION FOR EMPLOYMENT

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1 Our Companies do not discriminate in hiring or employment on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, ethnicity, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state and local laws. No questions on this application are intended to secure information to be used in such discrimination. The use of this form does not mean positions are open, and does not obligate the company, in any way. Date of application APPLICATION FOR EMPLOYMENT PLEASE WRITE CLEARLY. Application must be complete, truthful and legible. Answer all questions in ink. Last Name First Name Middle Name Address Apt. City State Zip Code Primary Phone # Secondary Phone # Address How did you learn about employment at our company? Advertisement Social Media Walk-in Other Employee Referred by: Customer Desired Position: Full Time Part Time Temporary Seasonal Other Working Hours/Dates Required: If Part Time, # of hours desired: Salary Expectation: Please read and answer all the questions below: YES NO Are you over 18 years of age? Have you ever filled an application with Miskelly before? Have you ever been employed by Miskelly before? Do you have any relatives currently employed with us? If yes, give their name(s) and relationship? Are you currently employed? May we contact your present employer? On what date would you be available for work? Can you travel if a job requires it? Are you legally authorized to work in the U.S. on a full-time basis? Are you working for the military? Branch: Full Time Length of time served: My attendance record at my last place of employment was: Total number of days absent from school or work this past year: Reserve Excellent Good Satisfactory Fair

2 School Name City, State EDUCATION High School College Graduate School Other Last Year Attended Did you Graduate? Diploma/Degree List any licenses, certifications, specialized training, skills, apprenticeships, or extracurricular activities List any honors received EMPLOYMENT HISTORY Start with your present or last job, including any military service or part-time employment. Use a separate sheet if necessary to complete any of this information. A resume may be included, but the information below must be completed as well. of company rules at this organization? Yes No If yes please explain. of company rules at this organization? Yes No If yes please explain. of company rules at this organization? Yes No If yes please explain.

3 of company rules at this organization? Yes No If yes please explain. of company rules at this organization? Yes No If yes please explain.

4 CRIMINAL CONVICTIONS: Have you been convicted of a crime (other than a minor traffic offense) or pled no contest to a crime? Yes No If Yes, please answer the following: For each conviction, please provide the following information: Length of Sentence/ Date Offense Place of Conviction Amount of Fine Please provide any additional information, including rehabilitation efforts, which you would like considered regarding any conviction you have disclosed. Answering Yes to this question will not necessarily disqualify you from the position desired. Any conviction and the circumstances will be evaluated in relation to the position for which you are applying. REFERENCES: Give name and phone number of three references who are not related to you and are not previous or employers: 1. Name: Phone #: 2. Name: Phone #: 3. Name: Phone #: What types of computer software can you use? Other job related skills (licenses, certifications, etc): List any volunteer activities and community affiliations that you would like to share: Summarize any personal characteristics that may further qualify you for employment:

5 AUTHORIZATION FOR BACKGROUND INQUIRY I authorize Miskelly Furniture to conduct a background investigation on myself including, but not limited to, prior employment and earnings history. I understand this may include information as to my character, work habits, job performance, and experience, along with reasons for termination of past employment. I understand that any information obtained may be used to evaluate my qualifications for the position for which I am applying. I authorize, without reservation, any person or agency to furnish the above information to: Miskelly Furniture, Human Resource Department, 101 Airport Road, Jackson, MS I authorize that a photocopy or facsimile of my signature below may be used to obtain information. I further understand that to aid in the proper identification of my file or records, I am providing the following information: Print Full Name: Any prior names, maiden name, nickname, or aliases: (Please list ALL previous addresses for the last 10 years. Use an additional page if necessary.) Previous Mailing Address: City / State / Zip: Previous Mailing Address: City / State / Zip: Applicant s Statement I understand further that any misstatements/falsification or omissions in this application will result in a decision not to hire me or to discharge me if discovered only after hire. I understand that any other offer of employment by Miskelly Furniture will be conditioned upon successful completion of a post offer, pre-employment Drug Test, criminal conviction history and driving history. I hereby give my consent to any such examination(s). I agree to conform to the rules and regulations of Miskelly Furniture. I understand that my employment is at - will and can be terminated with or without cause and with or without notice, at any time, at the option of either Miskelly Furniture or myself. Date: Applicant Signature: This application for employment shall be considered active and on file for 30 days. An applicant wishing to be considered for employment after this time period should reapply by completing a new application: