APPLICATION FOR EMPLOYMENT

EQUAL OPPORTUNITY EMPLOYERWe are an Equal Opportunity Employer. We consider applicants for all positions without regard to race, color, creed, religion, sex, national origin, age,
marital or veteran status, the presence of a non-job-related medical condition or handicap, and any other legally protected status. It is our policy to abide
by all Federal, State, and local laws concerning discrimination in employment. No question in this application is intended to elicit information in violation
of any such law nor will any information obtained in response to any question be used in violation of any such law

PERSONAL INFORMATION

Date Of Birth

Date available to start

Are you a citizen of the USA ?

How long at present address ?

Are you employed ?

If no, explain

Valid drivers license number

Driver license state

Employment desired

Have you ever been convicted of any law violation
( other than a minor traffic violation ) ? A Yes answer
does not automatically disqualify you from employment
since the nature, date, and job you are applying for will be
considered

If yes, explain

EDUCATION AND TRAINING

Did you graduate?

Last year

List any other education, training, special skills

PRESENT EMPLOYER.

Starting Date

Ending Date

Reason for leaving

FORMER EMPLOYER.

Starting Date

Ending Date

Reason for leaving

AUTHORIZATION AND SEND -- PLEASE READ CAREFULLY BEFOR SENDING

By Sending I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if falsified statements on this application or interview shall be grounds for dismissal. I authorize investigation of all statement contained herein and the reference and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no
representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any
agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. I also understand that Libby's Clean
Shine requires a background check on all perspective employees.

Out of the 7 days in a week what days would accommodate you?
MON	TUS
WEN	THU
FRI	SAT
SUN