Personal Information
First Name: MI: Last Name:
Present Address:
City: State: Zip:
Referred By: Newspaper Ad  Friend  Personnel Agency
TV Ad  Radio Ad 

Employment Desired
Blacklion Locations
You Are Applying For:
Park Rd. Store, Charlotte, NC
Huntersville, NC
Dilworth Store, Charlotte, NC
Position Applied For:
Date You Can Start:
Salary Desired:
Are You Currently Employed?
Yes    No
If So, May We Contact Your Current Employer?
Yes    No
Have You Ever Worked For Or Applied To This Company?
Yes    No
If So, Where and When?
Where:    When:

Education History
  Name & Location of School Years Attended Did You Graduate? Subjects Studied
High School
Trade, Business or Other School

Former Employers (List Below Last Four Employers, Starting With The Most Recent)
Date (Month & Year) Name & Address of Employer Salary Position Reason for Leaving

SEEKING: Full Time    Part Time
Hours Available For Work: All Hours   A.M. Hours   P.M. Hours  
Days Available Monday  Tuesday  Wednesday  Thursday 
Friday  Saturday  Sunday 

Additional Skills or Training

References (Give the name of three persons not related to you, whom you have known for at least one year)
Name Address Business Phone Years Known

     I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
     I authorize the investigation of all statements contained herein and references 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.
     All employment at BLACKLION is open and at-will. All employees are hired on a ninety (90) day orientation period. At any time during this first ninety (90) days, BLACKLION or the employee may decide to terminate employment at any time for any reason without recourse, if either party feels it is their best interest to do so.

I agree to the terms and conditions stated above.