APPLICATION FOR EMPLOYMENT rue21 is an equal opportunity employer dedicated to non-discrimination in employment. rue21 selects the best qualified individual for the job based on job-related qualifications regardless of race, color, age, sex, religion, national origin, mental or physical disability, ancestry, marital status, veteran status or any other status protected by applicable law. All statements by applicants for employment on the application will be carefully checked for accuracy. The use of this form does not mean there are positions open and does not obligate us in any way.

PERSONAL INFORMATION
Name (Last) Present Address Permanent Address Phone Numbers
Home: Cell:

(First) City City Email Address No Yes

(M.I.)

Date of Application State State Zip Code Zip Code

Are you at least 16 years of age?

Are you eligible to work in the United States?

No

Yes

If below the age of 18, may be required to provide verification of permission to work.

All hires will be required to provide proof of eligibility to work in the United States.

Have you ever been discharged from a job? No Yes – please explain: ____________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Do you have any relatives currently employed by rue21?

Have you ever been convicted of a crime other than minor traffic violations or misdemeanor convictions for which probation was completed? No Yes – Please list the nature of the crime(s), the date & place of conviction and the legal disposition of the case. ____________________________________________________________ ____________________________________________________________
A conviction will not necessarily disqualify you from employment.

No

Yes – Name of relative: No Yes – Position:

Relationship: Location:

Have you interviewed by phone or in person with rue21 before?

EMPLOYMENT DESIRED
Position applying for (check all that apply, indicating part-time or full-time when applicable): Store Manager Assistant Manager Sales Associate Stock Associate
PT or Which rue21 location are you seeking employment? FT

Seasonal Associate
PT or FT

Other:______________ Current Salary: $______________________ Desired Salary: $______________________ Friday Saturday

___________________________
City

_____
State

Are you able to work overtime? Sunday Days/ hours available to work:

No Yes Monday

Have you ever worked for rue21 before? No Yes – When? __________________________ Which location? __________________ Wednesday Thursday

Tuesday

How did you hear about us:
Newspaper Careerbuilder rue21.com Friend Job Fair rue21 employee: _________________ Other: _________________

EDUCATION
Name and Address of School Circle Last Year Completed Did You Graduate? Subjects Studied/ Degrees Received

High School College Graduate School Trade, Business or Correspondence School

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

Y Y Y Y

N N N N

Please list any other qualifications/training you have for this position:________________________________________________

______________________________________________________________________________________________
PR-2 PLEASE CONTINUE ON BACK PAGE

WORK HISTORY
Current Employer

From ____/____
Month Year Year

Employer – Name, Address, Type of Business (i.e. retail, restaurant, accounting)

To

____/____
Month

Position Supervisor Name From ____/____
Month Year Year

Duties Performed Phone Number Reason for Leaving

Salary or Hourly Starting $_________ Ending $_________ Average hrs. per wk.
______________________

May we contact? No Yes Salary or Hourly Starting $_________ Ending $_________ Average hrs. per wk.
______________________

Previous Employer

Employer – Name, Address, Type of Business (i.e. retail, restaurant, accounting)