4
REFERENCES/APPLICANT STATEMENT
REFERENCES
1.
_____________________________________________________________________________________
Name
Phone Number
_____________________________________________________________________________________
Address
2.
_____________________________________________________________________________________
Name
Phone Number
_____________________________________________________________________________________
Address
3.
_____________________________________________________________________________________
Name
Phone Number
_____________________________________________________________________________________
Address
I certify that the information provided herein is true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in
arriving at an employment decision.
I understand that this application shall be considered active for a period of time not to exceed 90 days. I also
understand that any applicant wishing to be considered for employment beyond this time period should inquire as
to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment
relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time
and the Employer may discharge the Employee at any time with or without cause. It is further understood that this
“at will” employment relationship may not be changed by any written document or by conduct unless such change
is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or
interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of
the employer.
__________________________________________________
_______________________________
Signature of Applicant
Date
FOR PERSONNEL DEPARTMENT USE ONLY
Arrange Interview:
Yes
No
Remarks: ___________________________________________________________________________________
___________________________________________________________
___________________________
Interviewer
Date
Employed:
Yes
No
Date of Employment:______________________
Job Title:___________________ Hourly Rate/Salary:_____________________
Authorized by:______________________________________
____________________
Date
Notes:______________________________________________________________________________________
IT IS OUR MISSION TO SERVE OUR CUSTOMERS WITH THE MOST HELPFUL AND KNOWLEDGEABLE SALESPEOPLE IN THE RETAIL HARDWARE INDUSTRY