Store Address The Mall at Partridge Creek 17380 Hall Road Clinton Township, MI 48038 For More Information [email protected] 586.522.4711 APPLICATION FOR EMPLOYMENT Applicants are not required to give any information prohibited by law. Our employment policies are non-discriminatory with respect to age, sex, sexual orientation, creed, color, national origin, disability, religion, citizenship status, disabled veteran, or veteran status or other legally protected status. Position Applying For Application Date Date Available to Start Name: Last First Middle Present Address Street City State Zip Telephone E-mail address Home: ( ) Cell: ( Are you 18 years old or older? Yes No Are there any hours or days of the week you cannot work? If so, when? Desired Pay Type of Employment Have you ever applied to this Company before? Education $__________ per hour Full-time Part-time Yes Yes ) No per year No Where? School and Address When? # Years Attended Did you Graduate? Subject/Major High School College Specialized Training Please provide any additional information such as special skills, training, management experience, equipment operation, or qualifications you feel will be helpful to us in considering your application: Are you legally permitted to work in the United States without restrictions? No Yes Have you ever been convicted of any offense in any court except for a minor traffic violation? If so, please the date and place, charge and disposition where offense occurred: PROFESSIONAL/ PERSONAL REFERENCES: CURRENT AND FORMER EMPLOYERS: (Most Recent First) Name Dates: Month/Year May we contact the employers listed? Yes If not, which one(s) and why not? Address/Phone Employer (name, phone, address) No Yes # Years Acquainted Salary (Starting/Ending) Position Held Relationship Reason for Leaving No Please read the following statement carefully before signing to indicate your understanding:  I understand that prior to being offered employment I may be requested to take an employment examination. In the event that I have a disability that will affect my ability to take the test, I will so inform the Company prior to the administration of the test so that a reasonable accommodation can be made. Post employment offer, the Company reserves the right to require medical documentation regarding the need for accommodation.  I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed falsified statements on this application may result in termination.  I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated with or without cause, at any time, with or without notice.  I authorize BlackFinn to investigate all information in this application and to secure additional information in the course of that investigation. I authorize all references, and any other persons contacted, to answer all questions asked related to my ability, reputation, character and previous employment record. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT Date Signature 5/16/15