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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