Question Title

* 1. Which locations are you interested in working at?

Question Title

* 2. Contact Information

Question Title

* 3. Are you over the age of 18?

Question Title

* 4. Have you ever been convicted of any crime (excluding minor traffic violations) including DWI?

Question Title

* 5. Employment Desired:

Question Title

* 6. Pay desired per hour:

Question Title

* 7. Date available to start:

Question Title

* 8. Have you ever applied with Lucy's Gift Boutique before?

Question Title

* 9. If you answered yes to the previous question, please tell us where.

Question Title

* 10. Have you ever worked for Lucy's Gift Boutique?

Question Title

* 11. If you answered yes to the previous question, please tell us where.

Question Title

* 12. How did you learn Lucy's Gift Boutique was hiring?

Question Title

* 13. Are there any days/evenings or hours you would be unwilling or unable to work? If yes please specify.

Question Title

* 14. List names of employers in consecutive order with present or last employer listed first.

Question Title

* 15. List names of employers in consecutive order with present or last employer listed first. 

Question Title

* 16. List names of employers in consecutive order with present or last employer listed first.

Question Title

* 17. Please provide references.

Question Title

* 18. Please provide references.

Question Title

* 19. Please provide references.

Question Title

* 20. Are you comfortable with computers?

Question Title

* 21. Do you have previous cash register experience?

Question Title

* 22. Do you have merchandising experience?

Question Title

* 23. Do you have any limitations that may affect your ability to perform the job for which you are applying?

Question Title

* 24. If you answered yes to the previous question, please explain:

Question Title

* 25. Will you abide by the safety rules of Lucy's Gift Boutique?

Question Title

* 26. Are you willing to take a physical exam and/or drug screen test at company expense?

Question Title

* 27. Have you used any illegal drug, including marijuana, in the last 12 months?

Question Title

* 28. If you have worked, in any of your previous positions, under a different name, please give that name:

Question Title

* 29. Are you presently employed?

Question Title

* 30. If you answered yes to the previous question, my we contact your present employer?

Question Title

* 31. Please use the space below to describe why you are interested in working for Lucy's Gift Boutique. Let us know about any skills or abilities that you feel particularly qualify you for a position with us.

Question Title

* 32. I certify that the answers given by me to the foregoing questions and statement are true and correct without any consequential omissions of any kind whatsoever. I understand that any misleading or incorrect statements may render this application void, and if employed, would be cause for termination. I further agree that the company shall not be liable in any respect if my employment is terminated because of falsity of statements, answers, or omissions made by me in this questionnaire. I also authorize the companies, schools, or persons named above to give any information regarding my employment, character and qualifications and hereby release said companies, schools, or persons from all liability for any damage for issuing this information. I certify that all statements and answers about my health are true and were made without reservations and agree to expressly waive all provisions of law prohibiting any physician, person, hospital, or other institution from disclosing to the company any information regarding treatment rendered now and in the future. I further understand that the taking of drug tests is a condition of employment and refusal to take such a test when asked will subject me to termination. I also understand that no person is authorized to enter into any written or verbal employment contracts on behalf of the company without the express written consent of the owner. 

Question Title

* 33. Please enter the date and time of the completion of this application

Date / Time

T