Form 8850 - Big Lots Job Application Form - Job Application Review (Page 2 of 4) in pdf

EMPLOYMENT HISTORY

BEGINNING WITH YOUR MOST RECENT EMPLOYER, LIST ALL EMPLOYMENT INCLUDING MILITARY SERVICE AND SELF-EMPLOYMENT. Please account

for all periods of unemployment. All sections of this application must be complete even if a resume is attached.

If presently employed, may we contact your employer for references?

Yes

May we contact you at your place of employment?

Yes

Name of present or last employer

Job Title/Responsibilities

From (Mo. & Yr.) To (Mo. & Yr.)

Supervisor Name

Address

Was your position

Full time

Part time

Starting Salary $

City, State, ZIP

Reason for leaving

Terminated

Voluntary

Involuntary

Explain

Last Salary $

Phone Number

(

)

Name of previous employer

Job Title/Responsibilities

From (Mo. & Yr.) To (Mo. & Yr.)

Supervisor Name

Address

Was your position

Full time

Part time

City, State, ZIP

Reason for leaving

Terminated

Voluntary

Involuntary

Starting Salary $

Explain

Last Salary $

Phone Number

(

)

Name of previous employer

Job Title/Responsibilities

From (Mo. & Yr.) To (Mo. & Yr.)

Supervisor Name

Address

Was your position

Full time

Part time

Starting Salary $

City, State, ZIP

Reason for leaving

Terminated

Voluntary

Involuntary

Explain

Last Salary $

Phone Number

(

)

Name of previous employer

Job Title/Responsibilities

From (Mo. & Yr.) To (Mo. & Yr.)

Supervisor Name

Address

Was your position

Full time

Part time

Starting Salary $

City, State, ZIP

Reason for leaving

Terminated

Voluntary

Involuntary

Explain

Last Salary $

Phone Number

(

)

Name of previous employer

Job Title/Responsibilities

From (Mo. & Yr.) To (Mo. & Yr.)

Supervisor Name

Address

Was your position

Full time

Part time

City, State, ZIP

Reason for leaving

Terminated

Voluntary

Involuntary

Starting Salary $

Explain

Last Salary $

Phone Number

(

)

I understand that Big Lots may contact the past employers and/or personal references I have provided in order to verify my past employment and

work record. I authorize all past employers, educational institutions, government agencies and/or personal references to release any and all information

concerning my past employment work history, performance, and personal character. I hereby release all such employers, personal references, and Big

Lots from any and all liability resulting from damages I may incur in the reference verification process. I understand that my employment or continued

employment is contingent upon my successfully completing both reference and background checks.

I also understand that if employed by Big Lots, my employment is “at will” and can be terminated at any time for any reason either by myself or the

Company. This agreement cannot be modified by any representative of the Company either in writing or verbally.

Finally, I understand it is unlawful for Big Lots to employ anyone who is neither a citizen of the U.S. nor an alien authorized to work in the U.S. I certify

that any U.S. citizenship/work authorization information I provide to the Company is authentic. Further, I certify that all information I have provided on this

application is accurate.

False information or omission of facts on this application may result in the termination of my employment with Big Lots.

Applicant’s Signature

Date

Thank you for your interest and the time you have taken to submit this application.