Explore a career in home fashion and retail marketing

Have you ever worked for or applied to work at Gabberts?* Yes No
If yes, where or when?

Are you over 18 years of age?* Yes No

Have you ever been convicted of a criminal offense?* Yes No
If yes, give details Conviction is not necessarily a bar to employment.

Can you, after employment, submit verification of your legal right to work in the U.S.?*
Yes No
Only U.S. citizens or aliens who have a legal right to work in the U.S. are eligible for employment. Verification will be required upon employment.

Referred to Gabberts by:

EMPLOYMENT INTEREST/SKILLS

Position applying for*
Wage/Salary expected:*
Location preference*
Date available for work:*

Full-time Part-time Temporary*

Are there any hours or days you cannot work?* Yes No
If yes, explain

Some roles require weekend hours. Could you do this?* Yes No

Are you available to work overtime?* Yes No
If no, explain

Certain positions within the company require use of a motor vehicle. If use of such a vehicle were required in the job for which you are applying, do you have or can you obtain a valid driver’s license?* Yes No
Do you have access to a motor vehicle?* Yes No
Do you have or can you obtain liability insurance on the vehicle?* Yes No

What unique qualifications, skills, experience or interests do you bring to Gabberts?

EDUCATION

	Name	Location	Course of study	Degree earned
High School
College/vocational
Graduate studies
Technical/other

EMPLOYMENT
Please list ALL JOBS, beginning with your present or last employer. Account for ALL time periods, including unemployment, self-employment and U.S. Military Service. Start with your present or most recent employer.

Employer 1*

Present or last employer*
City*
State*
Telephone Number*	( ) xxx-xxxx
Type of Business*
Dates employed*	from to
Job Title*
Department*
Supervisor*

Duties and Responsibilities (include skills that you could apply at Gabberts)*

Last salary* (ie: 20000.00)
Reason for leaving*

May we contact your present employer?* Yes No

Employer 2

Employer
City
State
Telephone Number	( ) xxx-xxxx
Type of Business
Dates employed	from to
Job Title
Department
Supervisor

Duties and Responsibilities (include skills that you could apply at Gabberts)

Last salary
Reason for leaving

Employer 3

Employer
City
State
Telephone Number	( ) xxx-xxxx
Type of Business
Dates employed	from to
Job Title
Department
Supervisor

Duties and Responsibilities (include skills that you could apply at Gabberts)

Last salary
Reason for leaving

Employer 4

Employer
City
State
Telephone Number	( ) xxx-xxxx
Type of Business
Dates employed	from to
Job Title
Department
Supervisor

Duties and Responsibilities (include skills that you could apply at Gabberts)

Last salary
Reason for leaving

PROFESSIONAL REFERENCES
List only those people who can attest to your past work performance.

Reference 1

Name
Business/Organization
Phone	( ) xxx-xxxx
Title

Reference 2

Name
Business/Organization
Phone	( ) xxx-xxxx
Title

Reference 3

Name
Business/Organization
Phone	( ) xxx-xxxx
Title

MOTOR VEHICLE DRIVER APPLICANTS
Applicants for motor vehicle driver positions please provide the information requested below:

Type of license you now have
State
License Number

Ever revoked? Yes No
If yes, explain

DRIVING EXPERIENCE

From (Mo./Yr.) To (Mo./Yr.)
Name and Address of Company
Type of Vehicle

From (Mo./Yr.) To (Mo./Yr.)
Name and Address of Company
Type of Vehicle

VOLUNTARY SELF-IDENTIFICATION
(CONFIDENTIAL- FOR STATISTICAL USE ONLY)

We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or any other classification protected by federal, state or local law. The information below will be used only in the compilation of data for affirmative action reporting.

Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment, if hired. Identification can be declared at any time prior to or, if applicable, after hire.

RACE / ETHNICITY:

A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

A person having origins in any of the original peoples of Europ, the Middle East, or North Africa.

A person having origins in any of the black racial groups of Africa.

A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, japan, Korea, Malaysia, Pakistan, the Phillipine Islands, Thailand, and Vietnam.

A person having origins in any of the original peoples of North and South America (including Central American), and who maintain tribal affiliation or community attachment.

All persons who identify with more than one of the above five races.

Applies to Applicants only, where a resume or application that is screened is received without any racial or ethnic identification and no further contact is made with the applicant.

Hispanic or Latino

White (Not Hispanic or Latino)

Black or African (Not Hispanic or Latino)

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)

Asian (Not Hispanic or Latino)

American Indian or Alaska Native (Not Hispanic or Latino)

Two or More Races (Not Hispanic or Latino)

Race missing or unknown

VETERAN STATUS:
(Please check one if it describes your veteran status.*)

SPECIAL DISABLED VETERAN: A veteran who is entitled to compensation (or who, but for the receipt of military retired pay, would be entitled to compensation) under laws administered by the Department of Veteran Affairs for a disability rated at 10 or 20 percent in case of a veteran who has been determined to have a serious employment disability or (B) a person who was discharged or released from active duty because of a service-connected disability.

VIETNAM ERA VETERAN: A Vietnam Era veteran is a person who (1) served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964, and May 7, 1975, and was discharged or released with other than a dishonorable discharge; (2) was discharged or released from active duty for a service connected disability if any part of such active duty for a service connected disability if any part of such active duty was performed between August 5, 1964, and May 7, 1975; or (3) served on active duty for more than 180 days and served in the Republic of Vietnam between February 28, 1961, and May 7, 1975.

Please read carefully:
By submitting this online form, I certify that the information provided in this employment application (and accompanying resume or documentation, if any) is true and complete. I understand that falsification of such statements and information is grounds for immediate dismissal in accordance with Gabberts policy. In consideration of my employment, I agree to conform to the rules and regulations of Gabberts and realize that my employment and compensation can be terminated at any time, with or without notice, by the Company or myself. I understand that no Gabberts representative has the authority to enter into any other agreement with me for employment for any specified period of time or to make any agreement contrary to the foregoing statement.

I understand that employment may be contingent upon passing a job-related pre-employment physical and/or motor vehicle records check if included in the position requirements.

I agree and authorize Gabberts to verify any statements made on this application and I authorize all previous employers or other persons having knowledge of myself or my record to release such information to Gabberts.

I hereby release those companies and persons and Gabberts from all claims or liabilities that may arise by such disclosure or such investigation.

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