Mall51.com Employment

Mall51.com Business Opportunity Application 1st Step

Personal Data
Email
Last Name	First Name		Middle Initial	Date
Street Address				Home Phone
City		State	Zip	Business Phone
Age, if minor or over 65	Social Security			Position Desired
Have you ever applied for employment with us?		How did you hear about us?		Employment Term
Do you have any family, business, health or social obligations that would prevent you from: Working Consistently Yes No Working Long Days and Weekends Yes No				Minimum Income per Month
Overnight Travel Yes No		If yes to any above, please explain:
Who would you like us to notify in an emergency?
Name	Relationship	Home Phone	Business Phone

General Data
Have you ever been convicted of a felony?	If yes, please explain:
Do you have any friends or relatives in our employ, or with any competitors?	If yes, please explain:
Do you have a valid drivers license? State License Number Type
List all traffic convictions over the last 3 years:	Has you drivers license ever been revoked?
Do you currently have any outside business interests?	Are you currently a student? Explain:

Education
School Attended Diploma/Degree	High School College		Subjects
Tech School		Programs
Have you graduated or are you currently enrolled? Graduated Enrolled Other If other, please explain:
Graduation Date (High/Tech Schools)	Graduation Date (Colleges)
Additional educational, certificates, special skills, professional memberships, civic organizations or awards:

Please provide an accurate, complete full-time and part-time employment history. Begin with your most recent employer.

Employment History
Company Name	Telephone
Address	Term Employed to
Name of Supervisor	Salary per
State job title and description of work	Reason for Leaving May we contact this employer? Yes No

Employment History
Company Name	Telephone
Address	Term Employed to
Name of Supervisor	Salary per
State job title and description of work	Reason for Leaving May we contact this employer? Yes No

Employment History
Company Name	Telephone
Address	Term Employed to
Name of Supervisor	Salary per
State job title and description of work	Reason for Leaving May we contact this employer? Yes No

Employment History
Company Name	Telephone
Address	Term Employed to
Name of Supervisor	Salary per
State job title and description of work	Reason for Leaving May we contact this employer? Yes No

Personal References
Name Years Acquainted	Relationship Phone
Name Years Acquainted	Relationship Phone
Name Years Acquainted	Relationship Phone

Please read and understand this statement before signing your application:

The information I have provided in this Application for Mall51.com opportunities is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my engagement.

I authorize the employer to contact and obtain information about me from previous employers,
educational institutions and “references” I provided, and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume or a personal interview. To assist in the processing of my Application, I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking, and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.

This application is not an employment agreement. If I accept an offer for any opportunity I understand
Mall51.com may terminate my position at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of Mall51.com, has authority to enter into any opportunity agreement with the terms contrary to the foregoing and then only in writing signed by such officer.

I fully understand and accept all terms and conditions in the above statement.