Fillable Form Wmp - 24 Z - Application Form For Employment Walmart Stores (Page 2 of 2) in pdf

Application for Employment

Wal-Mart Stores, Inc.

Employment History

List your entire employment history, beginning with your current employer. For any unemployed or

self-employed periods, provide dates and locations. (Attach additional sheets if necessary.)

If you are currently employed, may we contact your current employer? Yes

Company Name:

Your job:

Last pay rate:

Address:

Supervisor:

Reason for leaving:

City, State:

Dates Employed:

Zip:

Phone:

From

Company Name:

Your job:

Last pay rate:

Address:

Supervisor:

Reason for leaving:

City, State:

Dates employed:

Zip:

Phone:

From

Company Name:

Your job:

Last pay rate:

Address:

Supervisor:

Reason for leaving:

City, State:

Dates employed:

Zip:

Phone:

From

Company Name:

Your job:

Last pay rate:

Address:

Supervisor:

Reason for leaving:

City, State:

Dates employed:

Zip:

Phone:

From

References

List two people (not relatives) you have worked with who we may contact.

Name:

E-mail:

Phone:

Name:

E-mail:

Phone:

IMPORTANT – We are glad you are interested in joining the Walmart team. Please read the following statements carefully and return this application.

Wal-Mart Stores, Inc., in considering my application for employment, may verify the information set forth on this application and obtain

additional background information relating to my background. I authorize all persons, schools, companies, corporations, credit bureaus and

law enforcement agencies to supply any information concerning my background. I have read, understand and agree to this statement.

(Please initial here.) ______

I understand that Wal-Mart Stores, Inc. has a commitment to maintain an alcohol/drug-free workplace and that Walmart, unless prohibited by state

law, requires a drug screening test as a part of its selection and hiring process. I understand that such drug screening will consist of the testing of

a urine sample or other medically recognized test designed to detect traceable amounts of a controlled substance in my body. If after a second

confi rmatory test using the gas chromatography/mass spectrometry method, it is determined my specimen contains a controlled substance or was

adultered or substituted, I will be disqualifi ed from consideration for employment and any off er of employment will be withdrawn. I further under-

stand and agree that if I am employed, I may be required to submit to alcohol/drug-testing under certain circumstances during my employment. I

have read, understand, and agree to this statement. (Please initial here.) ______

I certify that the information on this application is correct and I understand that any misrepresentation or omission of any information will result in

my disqualifi cation from consideration for employment or, if employed, my dismissal. I understand that this application is not a contract, off er, or

promise of employment and that if hired, I will be able to resign at any time for any reason. Likewise, the company can terminate my employment at

any time with or without cause, unless otherwise required by law. I further understand that no one other than the President of Wal-Mart Stores, Inc.,

or Vice President of its People Division has the authority to enter into an employment contract or agreement with me, and that my at-will employ-

ment can be changed only by a written agreement signed by the President of Wal-Mart Stores, Inc. I have read, understand and agree to this state-

ment. (Please initial here.) ______

I understand that this application is good only for sixty (60) days from today’s date. If I still desire a position with the company after this application

expires, it will be my responsibility to complete a new application and fi le it with the company. Otherwise, the company will not consider me for

employment after this application expires.

Date of Application

Signature

(as appears on Social Security Card)

Wal-Mart Stores, Inc. will provide a reasonable accommodation during the application

Rev. June 2010

WMP - 24 Z

and/or hiring process for individuals with disabilities. Please advise us if you need

[9951356]

assistance with the application and/or hiring process to accommodate a disability.