Inc. Co.

Application for Employment www.atikastyles.com

Todays Date: ______________________________ How did you hear about the position? _________________

Read first before completing this employment application: It is important to fill out this form entirely. Please print (legibly) all information requested except signature. Do not leave section (s) blank. By doing so will void review of this document except for in the case of EEO and the receptionist position. Provide adequate phone numbers to contact you on (inform us if this is the best way for you to be reached). If you are unavailable have a voicemail, answer machine or someone to take a message to return our call. Three references are required. We will utilize the contact information bestowed in the education, references and employment sections. Furthermore, conduct a background that will be covered at your expense before hired. Equal Employment Opportunity: ATIKA Styles Inc. Co. imparts equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment.

Personal Data
Full Name: Current Address: Previous Address (if less than 2 years): Telephone Numbers:
Last First Middle Number and Street City State Zip Code

Number and Street

City

State

Zip Code

Home (area code):

Cell (area code):

Email address:

Marital Status: (Check One) Are you: Married? ___ Single? ___ Divorced? ___

Military Record
Are servicing in the armed forces? ___Yes or ___No If yes, please list below Branch of Service Discharge Date Rank

HAVE YOU EVER BEEN CONVICTED FOR A CRIME? __Yes or __ No If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. ___________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

Inc. Co.
Desired Employment
Position you are applying for: ________________ Date you can begin work: ___________________ Total hours desired per week: ________________ What type of work (circle one):
Part-time

M From To

Full-time Temporary
Where? When?

Have you ever applied at ATIKA Styles Inc. Co. before? Have you ever worked at ATIKA Styles Inc. Co.? Reason for leaving Name of the last Coach/Manager Do you know anyone that works at ATIKA Styles Inc. Co.? How did you hear about ATIKA Styles employment opportunity? (circle one)

Where?

When?

If yes, provide name:

No

Friend Relative Other

Walk In Website

If hired, can you provide proof of identity to work in the United States? (circle one)

Yes

No

If hired, would you have transportation to/from work? ___Yes or ___No Are you over the age of 18? ___Yes or ___No Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation? ___Yes or ___No If no, describe the functions that cannot be performed _____________________________________________________________________________________
(Note: Company complies with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)

Additional Information
Do you speak, write or understand any foreign languages? ___ Yes or ___No If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be. ____________________ Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention suited for working with us? ___Yes or ___No If yes, please explain
(Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying).

__________________________________________________________ __________________________________________________________
In order to complete hiring procedures at ATIKA Styles you may be required to participate in an assessment and math test for the position which you are applying. Do you object to this arrangement? _____

Inc. Co.
Education
Circle the highest grade completed: Elementary 4 5 6
14 15 16 17 18 19 Middle 7 8
State

High School 9 10 11 12

College 13

High School Diploma or GED received:

Name of the school

City

Yes

No

College: (List all, whether degree obtained or not) Name and location Major field of Study

Minor field of Study

Degrees/certification

Received?

*Note: Fill out only if applying for cosmetologist/manicurist/aesthetician (list all the schools attended):

Where did you attend school?

Name & Location

City

State

Phone Number

Type of license(s) attained?

Name of instructor (s):

References
Provide names, work relationships and telephone numbers of three individuals, supervisors, college professors or professional references not related to you whom you have known at least 12 months : Work Relationships Telephone Numbers Years Names Acquainted

We will contact all references, if you prefer us not to call please explain why: _______________________________ _____________________________________________________________________________________________ In case of accident or illness please contact: Name: _______________________________________________________________ Address: ____________________________________________________ Phone number (include area code): ____________________________________________________

Inc. Co.
Former Employers (list from last four employers beginning with the most recent)
Employer Address (Street, City, State) Telephone Number (s) Job Title Reason for leaving Dates Employed From: Employer Address (Street, City, State) Telephone Number (s) Job Title Reason for leaving Dates Employed From: Employer Address (Street, City, State) Telephone Number (s) Job Title Reason for leaving Dates Employed From: Employer Address (Street, City, State) Telephone Number (s) Job Title Reason for leaving Dates Employed From: Hourly Rate/Salary Starting: Supervisor Hourly Rate/Salary Starting: Supervisor To: Work performed Hourly Rate/Salary Starting: Supervisor Hourly Rate/Salary Starting: Supervisor Work performed

To:

Final: Work performed

Final:

To:

Final: Work performed

To:

Final:

Inc. Co.
Authorization
Please Read and Initial Each Paragraph, then Sign Below
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 permit investigation of all statements contained herein and the 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 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._________ If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the US, or have a physical examination and/or a drug test. _________ In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.___________

______________________________________________________________________________
SIGNATURE DATE

Thank you for your interest and applying at ATIKA Styles Inc. Co. We look forward to reviewing your application submission and will contact you in the near future when a position meeting your description becomes available.