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Form Name:   Kohls_Application
Tags:   kohls job application
Posted Date:   7/10/2010
Size:   94KB
Type:   .PDF
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Date EMPLOYMENT APPLICATION Name LastFirstMiddleHome Number Address Cell Number State ZipStreet City List any additional names which you have used which will permit us to check your work record: Position Applied For Date available to start work: AVAILABLE TO WORK: SUNMONTUEWEDTHUFRISAT FROM (START TIME) Full Time TO (END TIME) Part Time Kohl’s Department Stores is an Equal Employment Opportunity Employer and gives all applicants for employment equal consideration regardless of race, color, sex, religion, national origin, ancestry, age, physical or mental disability, sexual orientation, transgender status, genetic information, marital status, citizenship status, veteran status, pregnancy, height, weight, or any other status protected by federal, state or local law. Upon request and consistent with applicable laws, Kohl’s will provide reasonable accommodations to individuals with disabilities who need an accommodation to fully participate in the application process. Have you ever applied at or been employed by Kohl’s before? If yes, please give dates & location Have you ever worked for Kohl’s in the capacity of a temporary employee and/or contracted employee? _______________ If yes, please explain. __________________________ Are you legally entitled to work in the United States? If hired, can you provide documentation of this eligibility? Are you 18 years of age or older?_______________ If no, state your age _________________ Do you have any friends or relatives employed by Kohl’s? If yes, give names and locations Employment History – First list all current employment, then list all previous employment. Company Name and Address From Mo./Yr. To Mo./Yr. Position Title Supervisor’s Name Starting Salary Ending Salary Reason for Leaving 1.  2.  3.  4.  Please explain all periods of unemployment: From  To  Reason From  To  Reason From  To  Reason AR-017E 06/2010 We conduct pre-employment drug screening for some positions. Are you willing to submit to a drug test? Yes_______ No _______ BEFORE ANSWERING the following questions, please refer to the instructions that follow if you are applying for a position in California, Connecticut, Illinois, Massachusetts, New York, Utah, or Washington. Have you ever been convicted of or plead guilty to a crime? (Answer NO for any annulled, expunged or sealed records; minor traffic offenses; or any conviction that was pardoned, discharged, or dismissed upon condition of probation). Yes _____ No _______ If you checked “Yes,” please explain below. A criminal conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe the nature of the crime and your subsequent rehabilitation. If yes, provide details__________________________________________________________________________________________________________________________________________________________________ INSTRUCTIONS - CRIMINAL CONVICTIONS QUESTIONS California Applicants: You may answer “No Record” with respect to any conviction for a marijuana offense if the conviction occurred more than two years prior to the date this application is completed. In addition, do not provide any information regarding a referral to and participation in any pre-trial or post-trial diversion program. Connecticut Applicants: You are not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have been erased. Conn.Gen.Stat. Sections 46b-146, 54-76o or 54-142a. Criminal records subject to erasure pursuant to Conn.Gen.Stat. Sections 46b-146, 54-76o or 54-142a are records related to (a) determinations of “delinquency” or that, as a child, you were a member of a family with service needs, (b) a ruling you are a “youthful offender”, (c) a finding you are not guilty for a criminal charge, or (d) a conviction for which you have received an “absolute pardon”. Any person whose criminal records have been erased pursuant to Conn. Gen.Stat. Sections 46b-146, 54-76o or 54-142a shall be deemed to never have been arrested within the meaning of the general statutes with respect to the proceedings so erased and may so swear under oath. Illinois Applicants: You are not required to reveal any expunged convictions, including expunged juvenile convictions. Massachusetts Applicants: If you have a sealed record on file with the commissioner of probation you may answer “No Record” with respect to any inquiry herein relative to prior arrests, criminal court appearances or convictions. You may answer “No Record” with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution. In addition, you may answer “No Record” with respect to a first conviction for: (1) the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violation, affray or disturbances of the peace; or (2) any misdemeanor conviction where the date of conviction or any resulting incarceration occurred five (5) or more years ago. New York Applicants: You may answer “No Record” with respect to any youthful offender conviction. Utah Applicants: You may answer “No Record” with respect to any conviction for a misdemeanor or summary offense. Washington Applicants: Answer “Yes” only if the conviction or release from imprisonment was within the last ten (10) years, or related to the functions of the position for which you are applying. ADDITIONAL STATE INFORMATION Maryland / Massachusetts Applicants: It is unlawful for an employer to require or demand as a condition of employment, prospective employment, or continued employment, that any individual submit to or take a lie detector or similar tests. An employer who violates the law is subject to criminal penalties and fines. Rhode Island Applicants: Kohl’s is subject to Chapters 29-38 of Title 28 of the General Laws of Rhode Island and is therefore covered by the state’s workers’ compensation law. APPLICANT’S STATEMENT I have read and fully understand the questions asked in this application. I certify that all of the answers I have given are true, accurate and complete. I understand that the omission and/or misrepresentation of any fact from or on this application or during any interview will result in immediate rejection of my application or if I am hired will be cause for immediate dismissal. Unless I noted otherwise, I authorize the Company to contact all my employment references and personal references, as well as the education institutions I have attended. I further authorize the Company to inquire about, investigate and obtain copies of any records which relate to me from my former employers and educational institutions. I hereby release Kohl’s and all affiliated persons and entities, as well as any person or institution that provides Kohl’s with any lawful information about me, from any and all liability whatsoever resulting from any such lawful inquiry, investigation or communication. If hired, I agree to abide by all of the rules and regulations of the Company. I understand and agree that nothing in this application shall constitute an offer, a contract or a guarantee of employment for a specific period of time. If hired, I understand that my employment is at-will and may be terminated with or without cause and with or without notice at any time, at the option of either Kohl’s or myself. I further understand that no representative or agent of the Company, other than the Senior Vice President of Human Resources, has the authority to enter into any agreement for employment for any specific period of time, or to make an agreement contrary to the foregoing. I also understand that any agreement modifying my at-will employment status must be in writing and signed by the Senior Vice President of Human Resources. In addition, I understand that the Company and all plan administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms and conditions of employment. I understand that any hiring decision is contingent upon my successful completion of all of the Company's lawful pre-employment checks, which may include a background check. I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment checks. Signature ___________________________________________________ Date____________________________________ AR-017E 06/2010