Employment Application Important Note: Please answer any and all questions as completely and accurately as possible. Only complete applications will be considered. We are an equal opportunity employer, and do not and will not discriminate against any employee or applicant in any manner prohibited by law. This application will be considered active for a maximum of 90 days from the date of the application. PERSONAL DATA Last Name First Middle Today s Street Address City State Zip Telephone Alternate Phone Social Security Number ( ) ( ) - - Are you at least 18 years of age? If not, please provide date of birth Are you eligible to work in the U.S.? Driver s License Number State of Issuance Expiration Have you ever been convicted of a crime that may impact your employment with the Company? (Such conviction may be relevant, if job related, but does not necessarily disqualify you from employment.) If yes, when: If yes, please explain: Have you ever been placed on probation or terminated for Have you ever been disciplined or discharged for fighting, poor job performance? assault, or similar offence? Have you ever been disciplined or discharged for violation Have you ever been disciplined or discharged for of a company policy? insubordination? EMPLOYMENT GOAL Position desired Will you accept (check all that apply) available for work Full Time Part Time Seasonal Availability (please enter the times you are available to work on each day. Note: We are open 24 hours.) SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Important Note: You may be required to work different shifts and overtime. Is this acceptable to you? If not, please explain: REFERRAL AND APPLICATION HISTORY Have you ever been employed by our company? Were you referred for employment by one of the company s If yes, when: employees? If yes, who: Do you have any relatives who are presently (or have formerly been) employed by our company? If yes, who: EDUCATION Name/Location of School/College Course of Study Diploma/Degree? High School Community College College/University Graduate School Other (specify)
EMPLOYMENT HISTORY Directions: This section must be completed entirely (even if a resume is attached). Please list ALL employment, including temporary or part- time jobs held while in school or military. Record your present or most recent employment first. Then list remaining positions in reverse order. Be sure to provide the telephone number of all former supervisors. JOB RELATED ACTIVITIES List any post- graduate work, seminars, volunteer positions, or professional organizations where functions and experience would be related to the knowledge and skills required for the position you are seeking. Name and Occupation PERSONAL REFERENCES Telephone Number I understand and agree that any misrepresentation on this application will be sufficient cause for cancellation of an offer of employment, or termination of employment if I have been employed. I give the Company the right to gather information from all former employers, educational facilities, or others who know me or know of me. Furthermore, I understand that employment resulting from my application is not considered a contract for any specific period of time. Terms and conditions of employment and benefits may be changed with or without cause and with or without notice, at any time. If accepted for employment, I agree to abide by all of the Company s policies and procedures, and I agree that it is my responsibility to familiarize myself with these policies.
APPLICANT REFERENCE RELEASE I hereby authorize a representative from Cash Magic to contact any company, person, or educational institution I listed as a reference on my employment application. I hereby allow any company, person, or educational institute I listed as a reference on my employment application to disclose any information they may have regarding my qualifications for employment, including but not limited to employment dates, descriptions of jobs performed, salary and wage rates and personal attributes. I agree to release and discharge and s successors, employees, (former employer) (former employer) officers, and directors as well as any company, person or educational institution I have listed as a reference for all claims, liabilities, and causes of action, known or unknown, fixed or contingent, for providing or receiving any information regarding my qualifications for employment. This release includes but is not limited to, claims of defamation, libel, slander, negligence, or interference with contract or profession. Print Name
BACKGROUND INVESTIGATION CONSENT I,, understand that, as a condition of my consideration for employment with Cash Magic, or as a condition of my continued employment with Cash Magic, Cash Magic may obtain a consumer report that includes, but is not limited to, my creditworthiness or similar characteristics, employment and education verifications, social security verification, criminal background and civil litigation history, worker s compensation experience, personal interviews, DMV records, any other public records and any other information bearing on my credit standing, credit capacity, character, general reputation, personal characteristics, and trust worthiness. I hereby authorize and consent to Cash Magic s procurement of such a report. I understand that, pursuant to the Federal Fair Credit Reporting Act, Cash Magic will provide me with a copy of any such report, if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment with Cash Magic. I further understand that such a report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report. I release Cash Magic and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used. The following is my true and complete legal name and all information is true and correct to the best of my knowledge: Full Name (Printed) Maiden Name or Other Names Used Present Address How Long? City/State/Zip Former Address How Long? City/State/Zip * of Birth Driver s License Number Social Security Number State of License *NOTE: The above information is required for identification purposes only, and is in no manner used as qualifications for employment. Cash Magic is an Equal Opportunity Employer, and does not discriminate on the basis of Sex, Race, Religion, Age (40 and over), Handicap or National Origin.
DRUG TEST CONTINGENCY STATEMENT I understand that Cash Magic requires all new employees to take a pre- employment drug test. I also understand that, should employment be offered to me prior to taking the drug test, or prior to the Company receiving the results of my drug test, that the employment offer is contingent upon the test results. I also understand that if I begin employment with Cash Magic prior to the Company receiving the results, and the test results are unfavorable, the Company has the right to terminate my employment based on the results of my drug test. Print Name