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Please fill out the form below: Note: * = Required fields Please make sure you have filled in all required fields. Incomplete fields have been marked in red.
PERSONAL INFO*
Last*	First*	Middle
SS#*	Valid Email Address
Address*
City*	State*	Zip*
Phone #*	Cell Phone #
Are you at least 18 years or older?* YesNo
Are you prevented from lawfully becoming employed in this country because of visa or immigration status?* YesNo
IN CASE OF EMERGENCY NOTIFY*
Last*	First*	Middle
Address*
City*	State*	Zip*
Phone #*	Cell Phone #
EMPLOYMENT DESIRED*
Position you are applying for* Full TimePart Time
If Part Time, hours desired
Max hours you can work per week*
What days of the week are you available to work?* SunMonTueWedThrFriSat
What time of day are you available to start work?* Early MorningLate MorningAfternoonEveningOvernight
Date you can start*
EDUCATION*
High School Name*	Location*
Did you graduate from Hight School?* YesNo
College Name	Location
Did you graduate from College? YesNo
What was the Degree? AssociateBachelorsMasters
What was the major in?
Special Training or Special Skills you possess
FORMER EMPLOYERS*
Name of Present or Past Employer*
Address*
City*	State*	Zip*
Phone #*	Supervisor's Name*
Starting Date*	Ending Date*
Description of Responsibilities*
Reason For Leaving*
May we contact this employer?* YesNo

Name of Present or Past Employer
Address
City	State	Zip
Phone #	Supervisor's Name
Starting Date	Ending Date
Description of Responsibilities
Reason For Leaving
May we contact this employer? YesNo

Name of Present or Past Employer
Address
City	State	Zip
Phone #	Supervisor's Name
Starting Date	Ending Date
Description of Responsibilities
Reason For Leaving
May we contact this employer? YesNo
EXPERIENCE AND SKILLS*
Retailer Experience (check all that apply)* KmartTargetWal-Mart Brook'sCVSWalgreen's Albertson'sFood LionKash n Karry KrogerPublixWinn-Dixie
Skills (check all that apply) Store ResetsCategory SetsNew Store Sets Display InstallationInventoryRetail Merchandising
Briefly explain your experience and qualifications (Please do NOT copy or paste your resume in this section)
REFERENCES*
Name*
Address
Phone #*	Email Address
Business*
Years Acquainted

Name*
Address
Phone #*	Email Address
Business*
Years Acquainted

Name
Address
Phone #	Email Address
Business
Years Acquainted
SPECIAL QUESTIONS*
The following information will provide RDM with information required for a bona fide occupational qualification, or dictated by national security laws, or is needed for other legally permissible reasons.
Were you ever seriously injured?* YesNo
If yes, please explain
Have you ever been convicted of a felony or misdemeanor within the last five (5) years?* YesNo
If yes, please explain
I understand and agree that I may be required to take one or more of the following: Physical Examination, Lie Detector Test(s) as a condition of hiring or continued employment. I agree to consent to take such test(s) at such time as designated by Retail Detail Merchandising and to relese Retail Detail Merchandising, it's directors, officers, agents or employees from any claim arising in connection with the use of such test(s) s* YesNo
Note: You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.
AUTHORIZATION*
"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to Retail Detail Merchandising’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at anytime, at either my or Retail Detail Merchandising’s option. I also understand and agree that the terms and condition of my employment may be changed, with or without cause and with or without notice, at any time by Retail Detail Merchandising. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has an authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the forgoing."* I Agree
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