APPLICATION FOR EMPLOYMENT

Minit Holdings, LLC

An Equal Opportunity Employer

Minit Holdings, LLC is an equal opportunity employer. We are dedicated to a policy of non-discrimination in employment on any basis including race, religion, color, sex, age, national origin, disability, veteran/military status and/or any other classification protected by federal, state and/or local law.

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Today's Date *

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General Information

Name *

First

Middle

Last

City *

State *Select a stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelewareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsonWyoming

ZIP Code *

Cell Phone Number *

E-Mail Address *

Referred By

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Employment Desired

Position Applying For *

Date You Can Start *

Full Time or Part Time? *

• Full Time
• Part Time

Are you employed now? *

• Yes
• No

If so, may we contact your present employer?

• Yes
• No

Have you applied to this company before? *

• Yes
• No

If yes, approximately when?

What store(s) are you applying for? *

• Fruit Valley Village
  1910 W Fourth Plain Blvd.
  Vancouver, WA 98660
• Felida Store
  12604 NW 36th Ave.
  Vancouver, WA 98685
• Vancouver Mall
  7107 NW Van Mall Dr.
  Vancouver, WA 98661
• St. Johns
  8817 St. Johns Rd.
  Vancouver, WA 98665
• Paradise Market (24 hours)
  32033 NW Paradise Park Rd.
  Ridgefield, WA 98642
• La Center Marketplace
  419 Cedar Ave.
  La Center, WA 98629

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Availability

Sunday *

Monday *

Tuesday *

Wednesday *

Thursday *

Friday *

Saturday *

Any additional comments concerning your availability?

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Educational Background

Name of High School *

Still attending? *

• Yes
• No

Name of College

Still attending?

• Yes
• No

Subject(s) Studied

Name Other Education

Still attending?

• Yes
• No

Subject(s) Studied

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Work Background

Please fill our your work background starting with your latest job working backwards. You need not account for more than the last 10 years.

Most Recent Employer

Address

City/State/ZIP

Telephone Number

Position

From

Approx. first date of employment

To

Approx. final date of employment. If currently employed here, enter today's date.

Job Duties

May we contact your employer for reference?

• Yes
• No

If yes, who is the specific person to contact? Please include their name and phone number.

Reason for Leaving

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Employer

Address

City/State/ZIP

Telephone Number

Position

From

Approx. first date of employment

To

Approx. final date of employment. If currently employed here, enter today's date.

Job Duties

May we contact your employer for reference?

• Yes
• No

If yes, who is the specific person to contact? Please include their name and phone number.

Reason for Leaving

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Employer

Address

City/State/ZIP

Telephone Number

Position

From

Approx. first date of employment

To

Approx. final date of employment. If currently employed here, enter today's date.

Job Duties

May we contact your employer for reference?

• Yes
• No

If yes, who is the specific person to contact? Please include their name and phone number.

Reason for Leaving

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Employer

Address

City/State/ZIP

Telephone Number

Position

From

Approx. first date of employment

To

Approx. final date of employment. If currently employed here, enter today's date.

Job Duties

May we contact your employer for reference?

• Yes
• No

If yes, who is the specific person to contact? Please include their name and phone number.

Reason for Leaving

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PLEASE READ CAREFULLY BEFORE SIGNING

By TYPING MY FULL NAME IN THE BOX BELOW, I certify that the information set forth in this Application for Employment is true and complete to the best of my knowledge. I understand that, if employed, false or misleading statements, misrepresentation, or omission of facts on this application shall be considered a violation of Minit Holdings, LLC's rules and will subject me to immediate termination. I understand that if offered employment, such employment shall be contingent upon proof of identity and verification of eligibility in the United States in accordance with the Immigration Reform and Control Laws. I authorize Minit Holdings, LLC to request of others including my current and any previous employers (except as previously noted on this application), any information concerning my previous employment, educational history, character, general reputation and similar background information. I here by release Minit Holdings, LLC and all parties and persons contacted to obtain any such information from all claims, liabilities, and demands for whatever reason.If employed, I agree to abide by Minit Holdings, LLC's policies and procedures. Futhermore, I understand that this is not a contract of employment, that I will not be employed for any specific period of time and that I may resign at any time with or without notice, and that Minit Holdings, LLC. may terminate my employment at any time, with or without cause and with or without prior notice and that any assurances of continued employment whether written, oral, or by conduct shall not be interpreted as changing that "at will" nature of my employment relationship with Minit Holdings, LLC unless specifically acknowledged in writing by an owner of Minit Holdings, LLC. *

Date *

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Minit Holdings, LLC Criminal Check Request Form

I, THE FULL NAME TYPED IN THE BOX BELOW, hereby release all information pertaining to my criminal, credit, military and work history to Loss Prevention Group. I am aware that all of the above references, as well as my credit report may be reviewed to determine my suitability for employment. I also understand that Loss Prevention Group may perform a background check on me at any time and that this Criminal Check Request Form will be sent to The Loss Prevention Group by Minit Holdings, LLC (by Jeff Larson, jlarson@tcgstores.com, (360) 892-2878). *

Have you ever been convicted of a crime? *

• Yes
• No

A YES answer will not necessarily disqualify you for employment.

If yes, please provide details and location(s).

Last Name of Applicant *

Maiden Name/Alias

First Name *

Middle Name *

If none, write "none".

Date of Birth *

Social Security Number

E-Mail Address *

Current Address *

City *

State *Select a stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelewareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsonWyoming

ZIP Code *

Previous Address

City

StateSelect a stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelewareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsonWyoming

ZIP Code

Counties and States lived in over the previous 7 years *

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By TYPING MY FULL NAME IN THE BOX BELOW, I acknowledge that all data provided is intended solely for the customer who initially receives such data from the provided. The provider cannot guaranty or warrant the accuracy, correctness, or completeness of the data. The provider delivers all data to customers on an "as is" "as available" basis without any express or implied warranty, guaranty, or representation of any kind concerning the data itself, its merchantability, or its fitness for a particular purpose of function. Neither the provider nor any of their affiliates shall be liable for any damages of whatever kind may result from the customer's reliance on (or use of) the data provided, even if the provider, or any of their affiliates has been alerted to the possibility of such damages. By assessing any such data, the customer acknowledges and agrees that the customer has not relied on anything that may be inconsistent with the Legal Statement. I understand that LPG, acting as the loss preventions department for the company I am seeking employment with, completes and provides criminal background check information to said company for final review for employment purposes. *

Date *

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