EMPLOYMENT APPLICATION
EMPLOYMENT APPLICATION
Please request any needed accommodations in the application process. Please print clearly. Failure to completely answer each question may disqualify you from consideration. CURO MANAGEMENT LLC IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO SEX, MARITAL STATUS, RACE, AGE, CREED, NATIONAL ORIGIN, GENDER, SEXUAL PREFERENCE, DISABILITY, OR ANY PROTECTED CLASS. . DATE: ______________
LAST NAME: _____________________________ FIRST NAME: ___________________________ M.I. _________
SOCIAL SECURITY NUMBER: Last 4 digits - ________ PHONE NUMBER: (_______) ________ -_________
EMAIL ADDRESS:____________________________________________________
PRESENT ADDRESS:
________________________________________________________ From: _______ To: _________
Street Address
City
State
ZIP
PREVIOUS ADDRESS:
__________________________________________________________ From: _______ To: _________
Street Address, City, State, and ZIP
What position are you seeking? ____________________________________ Location _______________________
What skills do you have to perform this position? ____________________________________
Wage Expected: ____________ Are you available to work: Full Time ___ Part Time ___ Evenings____ Weekends____
Date available to start work _____________________
Do you have any relative(s) or personal acquaintance(s) in our employ? Yes ____ No ____ If YES, list name(s) and relationship: ___________________________________________________________________
Have you ever applied for work with this company before? Yes ____ No ____ If yes, when _______________________
Have you ever been employed by this company before? Yes ____ No ____ If YES, when and where were you employed? When: _________________________ Where: _________________________
'RQRWDQVZHUWKHIROORZLQJTXHVWLRQLI\RXDUHDSSO\LQJLQWKH6WDWHsRI,OOLQRLV, California, Colorado, or Oregon, or in the city of Austin, TX Have you been convicted of a felony crime within the past 7 years? Yes ____ No ____ A conviction does not necessarily prevent an applicant from obtaining employment and will only be considered in relation to specific job requirements. If YES, explain: ___________________________________________________________________________
If hired, can you provide proof of your eligibility to work in the United States? Yes ____ No ____
Education
High School College Other
Name
City/State
Graduated Degree?
Please complete page 2
WORK EXPERIENCE
Please account for all periods of time.
Most recent employer
Currently employed: Yes or No
If yes, may we contact: Yes or No
Name:
Address:
State:
Zip:
From:
To:
Salary:
Reason for leaving:
Job Title: Supervisor: Duties:
Phone:
2nd most recent employer
Name:
From:
To:
Salary: Reason for leaving:
Address: Job Title: Supervisor: Duties:
State:
Zip:
Phone:
3rd most recent employer
Name:
From:
To:
Salary: Reason for leaving:
Address: Job Title: Supervisor: Duties:
State:
Zip:
Phone:
References
Include only individuals familiar with your work ability. Do not include relatives or supervisors listed above.
Name
Relationship
Address
Phone
I certify that I understand that the information given in this application will be used to evaluate my qualifications for employment. I understand that this is not an employment contract, nor does it guarantee employment. I certify that the answers given by me to the foregoing questions and the statements made by me are true and complete to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time of employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information prior to, and at any time during employment. I authorize all former employers, persons, schools, companies and law enforcement authorities from any liability for damage whatsoever for issuing this information. I agree to indemnify and hold harmless CURO Management LLC and any parent or related entity, its directors, officers, agents, and employees from and against any and all claims, demands or causes of action, and the reasonable and necessary costs, including attorney's fees, which I have or may have resulting from such pre-employment investigation(s) or post employment references by the Company. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to a drug test to detect the use of illegal drugs prior to and during employment. I understand that employment is "at will" and that employment with CURO Management LLC can be terminated at any time, with or without notice or cause. I also understand that no policy, practice or representative of the company can alter the at will relationship without written consent from an Owner of the company.
Name (please print) ______________________________________________________
Signature ______________________________________________________ Date ____________________________
This Employer Participates in E-Verify
This employer will provide the Social Security Administration
In order to determine whether Form I-9 documentation is valid,
(SSA) and, if necessary, the Department of Homeland Security
this employer uses E-Verify's photo screening tool to match
(DHS), with information from each new
the photograph appearing on some
employee's Form I-9 to confirm work authorization.
N O T I C E:
permanent resident and employment authorization cards with the official U.S.
IMPORTANT: If the Government cannot confirm that you are authorized to work, this employer is required to provide you written instructions and an opportunity to contact SSA and/or DHS before taking adverse action against you, including
Federal law requires all employers
to verify the identity and employment eligibility
of all persons hired to work in the United States.
Citizenship and Immigration Services' (USCIS) photograph.
If you believe that your employer has violated its responsibilities under this program or has discriminated against you during the verification process
terminating your employment.
based upon your national origin or
citizenship status, please call the Office of Special Counsel at
Employers may not use E-Verify to pre-screen job applicants or
1-800-255-7688 (TDD: 1-800-237-2515).
to re-verify current employees and may not limit or influence the
choice of documents presented for use on the Form I-9.
For more information on E-Verify, please contact DHS at:
1-888-464-4218
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