Return applications the following ways: Mail: Cambridge 405 2297 Wisconsin Ave Grafton, WI 53024 Fax: (888)

374-0388

APPLICATION FOR EMPLOYMENT

Todays Date:
Cambridge 405 is an equal opportunity employer and will consider all applicants for all positions without regard to their race, sex, age, color, religion, national origin, veteran status, or any disability as provided in the Americans with Disabilities Act. This application will be given every consideration, but its receipt does not imply that the applicant will be employed.

PERSONAL DATA
FIRST NAME STREET ADDRESS CITY, STATE AND ZIP CODE EMAIL ADDRESS DID A CAMBRIDGE 405 EMPLOYEE REFER YOU? Yes No MIDDLE NAME LAST NAME MAIDEN NAME PREFERRED NAME OR NICKNAME HOME PHONE NUMBER: MOBILE PHONE NUMBER: SOCIAL SECURITY NUMBER: If Yes, please state name below and relationship.

HAVE YOU EVER BEEN CONVICTED OF ANY CRIME (FELONY OR MISDEMEANOR)? Yes No If Yes, state the offense, location, date and results (disposition). Note: A "Yes" answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying will also be considered.

ARE YOU OVER THE AGE OF 18? No

Yes

No

If No, are you able to provide a workers permit?

Yes

NATURE OF EMPLOYMENT SOUGHT (Please check all that apply.)

TYPE OF WORK YOU ARE SEEKING? FULL-TIME PART-TIME SEASONAL TEMPORARY RETAIL SALES OR FLORAL DESIGN POSITION? DATE AVAILABLE FOR WORK? ARE YOU WILLING TO WORK NIGHTS, WEEKENDS AND HOLIDAYS IF NECESSARY? ARE YOU WILLING TO WORK OVERTIME IF NECESSARY? ARE THERE RESTRICTIONS ON THE DAYS/TIMES THAT YOU CAN WORK? If Yes, list the days and times NOT available to work: ARE YOU ABLE TO LIFT UP TO 50 POUNDS? Yes No NUMBER OF HOURS DESIRED PER WEEK? Yes Yes Yes No No No

EDUCATION
EDUCATION HIGH SCHOOL: NAME OF SCHOOL, CITY AND STATE DIPLOMA / DEGREE Diploma? Yes No GED Degree? Yes, Name Degree: No Degree? Yes, Name Degree: No MAJOR/ COURSE CERTIFICATION

COLLEGE:

OTHER:

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EMPLOYMENT HISTORY
Note: You may provide a resume if youd like, but employment history must be completed in detail. Start with your most recent employer. COMPANY NAME START DATE END DATE

ADDRESS (NUMBER, STREET, CITY, STATE, ZIP CODE)

STARTING SALARY $ NAME OF SUPERVISOR

ENDING SALARY $ SUPERVISOR TELEPHONE NUMBER

POSITION REASON FOR LEAVING YOUR DUTIES

COMPANY NAME

START DATE

END DATE

ADDRESS (NUMBER, STREET, CITY, STATE, ZIP CODE)

STARTING SALARY $ NAME OF SUPERVISOR

ENDING SALARY $ SUPERVISOR TELEPHONE NUMBER

POSITION REASON FOR LEAVING YOUR DUTIES

COMPANY NAME

START DATE

END DATE

ADDRESS (NUMBER, STREET, CITY, STATE, ZIP CODE)

STARTING SALARY $ NAME OF SUPERVISOR

ENDING SALARY $ SUPERVISOR TELEPHONE NUMBER

POSITION REASON FOR LEAVING YOUR DUTIES Note: If additional space is needed, attach separate page.

OTHER INFORMATION
MAY WE CONTACT YOUR PRESENT EMPLOYER FOR A REFERENCE? MAY WE CONTACT YOUR FORMER EMPLOYER(S) FOR A REFERENCE? If No, state which employer(s) we may not contact: IDENTIFY THE REASON FOR ANY GAP IN CONTINUOUS EMPLOYMENT: HAVE YOU EVER BEEN TERMINATED FROM OR ASKED TO RESIGN FROM A JOB? If Yes, explain the circumstances: Yes No Yes Yes No No

Your signature is required to complete this application. Turn to next page and sign/date.
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PLEASE READ CAREFULLY BEFORE SIGNING

All applicants will be given equal consideration regardless of race, age, sex, religion, disability or any other protected status. Applicants are not required to give any information on this form that is prohibited by federal, state or local law. The use or completion of this form does not mean that there are any positions open and does not in any way obligate Cambridge 405 (the Company) to offer employment. Any offer of employment is contingent upon successfully passing all tests, background checks, and/or examinations. Applicants for positions that require cash handling and/or other duties of a sensitive nature may have an investigative consumer report prepared regarding an applicants character, general reputation, personal characteristics, and mode of living. Additional information as to the nature and scope of such report, if made, will be provided upon applicants written request. I certify that the information given by me in this application is true and complete in all respects, and I agree that if the information given is found to be false or materially misleading in any way, it shall constitute sufficient cause for denial of employment or discharge. I authorize the use of any information in this application to verify my statements, and I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damage on account of having furnished such information. I understand that either the Company or I may terminate my employment at any time with or without notice, or with or without cause, and that the Company does not guarantee that any position be continued for any length of time or that any job assignment or shift to be permanent. I understand that if employed, policies and procedures, which are issued, are not conditions of employment and the Company may revise policies or procedures, in whole or in part, at any time. I also understand that I am required to abide by all rules and regulations of the Company. If a position of employment is offered, all new hires are subject to a probationary period of employment of 90 days, during which time they may be dismissed without notice. By signing this form, you are attesting that you have fully read, understood, and agree to all of the above stated information.

SIGNATURE OF APPLICANT

DATE

Thank you for your interest in Cambridge 405. www.Cambridge405.com

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CAMBRIDGE 405 EMPLOYMENT VERIFICATION WAIVER

NAME SOCIAL SECURITY NUMBER OTHER NAMES USED HOME ADDRESS HOW LONG HAVE YOU LIVED AT CURRENT ADDRESS? PREVIOUS ADDRESS

HOW LONG HAVE YOU LIVED AT PREVIOUS ADDRESS?

DATE OF BIRTH

DRIVERS LICENSE NUMBER / STATE OF ISSUE

In connection with my application for employment with Cambridge 405, I understand that investigative background inquiries may be made on myself, including criminal convictions, motor vehicle, credit, and other reports. These reports will include information as to my character, work habits, performance, and experience along with reasons for termination of past employment from previous employers. Further, I understand that an authorized representative of Cambridge 405 will be requesting information from various Federal, State, and other agencies that maintain records concerning my past activities relating to my driving, civil, and other experiences. I authorize without reservation any or agency contacted by this potential employer to furnish the abovementioned information. I also release Cambridge 405 and any other person from damage and/or liable acts that may result from obtaining this background check. The above information is used solely for employment verifications, criminal history, and credit checks. Falsifying any information on this release form will constitute grounds for immediate dismissal. I also understand that if I am asked to begin employment prior to successful completion of this background check, my employment is to be considered temporary and is contingent upon the successful completion of this background check.

SIGNATURE OF APPLICANT

DATE

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