Name (Last) Present Address Permanent Address Phone Numbers
(First) City City Email Address No Yes
Date of Application State State Zip Code Zip Code
Are you at least 16 years of age?
Are you eligible to work in the United States?
If below the age of 18, may be required to provide verification of permission to work.
All hires will be required to provide proof of eligibility to work in the United States.
Have you ever been discharged from a job? No Yes – please explain: ____________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Do you have any relatives currently employed by rue21?
Have you ever been convicted of a crime other than minor traffic violations or misdemeanor convictions for which probation was completed? No Yes – Please list the nature of the crime(s), the date & place of conviction and the legal disposition of the case. ____________________________________________________________ ____________________________________________________________
A conviction will not necessarily disqualify you from employment.
Yes – Name of relative: No Yes – Position:
Have you interviewed by phone or in person with rue21 before?
Position applying for (check all that apply, indicating part-time or full-time when applicable): Store Manager Assistant Manager Sales Associate Stock Associate
PT or Which rue21 location are you seeking employment? FT
PT or FT
Other:______________ Current Salary: $______________________ Desired Salary: $______________________ Friday Saturday
Are you able to work overtime? Sunday Days/ hours available to work:
No Yes Monday
Have you ever worked for rue21 before? No Yes – When? __________________________ Which location? __________________ Wednesday Thursday
How did you hear about us:
Newspaper Careerbuilder rue21.com Friend Job Fair rue21 employee: _________________ Other: _________________
Name and Address of School Circle Last Year Completed Did You Graduate? Subjects Studied/ Degrees Received
High School College Graduate School Trade, Business or Correspondence School
1 1 1 1
2 2 2 2
3 3 3 3
4 4 4 4
Y Y Y Y
N N N N
Please list any other qualifications/training you have for this position:________________________________________________
PR-2 PLEASE CONTINUE ON BACK PAGE
Month Year Year
Employer – Name, Address, Type of Business (i.e. retail, restaurant, accounting)
Position Supervisor Name From ____/____
Month Year Year
Duties Performed Phone Number Reason for Leaving
Salary or Hourly Starting $_________ Ending $_________ Average hrs. per wk.
May we contact? No Yes Salary or Hourly Starting $_________ Ending $_________ Average hrs. per wk.
Employer – Name, Address, Type of Business (i.e. retail, restaurant, accounting)…