Charlotte Russe Job Application Form - Job Application Review Page 2

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Education & achievements

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Professional references

Reference

Street Address

City

State

Zip

Phone

Email

Job Title

How acquainted and for how long?

Reference

Street Address

City

State

Zip

Phone

Email

Job Title

How acquainted and for how long?

Additional employment inquiries

Have you ever been dismissed or forced to resign from any employment? Yes  No

Please be advised that a consumer report or an investigative report may be obtained from a consumer reporting agency for the purpose of evaluating you for employment,

If yes, please explain:

promotion, reassignment, or retention as an employee. This report may contain information bearing your character, general reputation, personal characteristics, or mode of living from public

record sources or through personal interviews with your neighbors, friends or associates. Prior to procuring such a report an authorization will be requested requiring your signature.

Permission to work

Are you legally authorized to work in the United States? Yes  No

Are you able to perform the essential functions of the job, with or without accomodation, for which you are applying? Yes No

If no, describe the functions of the job that cannot be performed. (We comply with the ADA and State law and consider reasonable accomodation measures that may be necessary to enable eligible applicants

to perform essential functions. Hires may be subject to passing a medical examination and/or skill agility tests.)

Applicant statement

If I become employed, I agree to abide by the rules and regulations of Charlotte Russe Holding Inc. I understand my employment is at-will. This means I do not have a contract of emplyment for

a particular duration or that it limits the grounds for my termination in any way. I am free to resign at any time. Similarly Charlotte Russe Holding Inc. is free to terminate my employement at any

time for any reason. I understand that while personnel policies, programs, and procedures may exist and be changed from time to time, my at-will status could be changed only if I were to enter into any

express written contract with Charlotte Russe Holding Inc. explicitly promising me job security containing the words “This is an express contract of employment” and signed by an officer of Charlotte Russe

Holding Inc.

All the information I have supplied in this application is a true and complete statement of the facts and if employed, any false statement or omission could result in immediate dismissal. I

understand that Charlotte Russe Holding Inc. may share the informtation in this application with other Charlotte Russe employees for employement and administrative purposes and hereby

consent to such a transfer. I further authorize Charlotte Russe Holding Inc. to contact my references, as well as current and previous employers to obtain information on my work history and

qualification for employment.

This application will only be considered for 3 months. If you have not been hired within 3 months of filling out this application and you wish to still be considered for employment you must fill out another application.