Fillable Printable Dollar General Application Form
Fillable Printable Dollar General Application Form
Dollar General Application Form
EMPLOYMENT
Have you ever worked for Dollar General? Yes No If yes, where: __________________________________________________
When: ___________ Under what name: _______________________ Reason for leaving: ____________________________________
Position(s) desired: Pay Expected:
When will you be available to begin work? ____________________ Will you have a reliable means of transportation?
Yes No
How many hours per week would you expect to work? __________ Are you available to work:
Part-time Full-time
When are you available to work?
Many of our stores are open for business on holidays, weekends, and special events. While we attempt to reasonably
(including sincerely held religious beliefs), ultimately the work schedules are based on business needs and may be subject to change on a weekly basis.
Do you have experience working in a distribution center or warehouse? Yes No
Do you have experience working in a retail store?
Yes No
If applying at a store location, why do you want to work in a sales oriented environment? _____________________________________
______________________________________________________________________________________________________________
What customer service experience do you have? ______________________________________________________________________
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
From
To
Application for Employment
PERSONAL INFORM ATION
Complete all areas of the application in black ink.
An incomplete or inaccurate application may delay consideration for employment.
Full name: ______________________________________________________ Social Security Number: X X X – X X – ___ ___ ___ ___
Print name as it appears on your Social Security card
Present address: ________________________________________________________________________________________________
Street City State Zip code
Primary phone: _________________________________________ Alternate phone: _________________________________________
When is the best time to call? ______________________________ Preferred phone:
Primary Alternate
Email address: __________________________________________ Are you 18 years of age or older?
Yes No
You must be at least 18 years of age to work for Dollar General unless otherwise required by law.
EDUCATION
School Name and Location of School Course of Study
Circle number of
years completed
Did you
graduate?
Degree or
Diploma
High School 1 2 3 4
Yes No
Vocational or
Business
1 2 3 4
Yes No
College 1 2 3 4
Yes No
Graduate 1 2 3 4
Yes No
Specify professional designations, certifications, licenses or registrations held related to the job(s) applied for: __________________
_____________________________________________________________________________________________________________
Issued in what state? ____________________ Expiration Date: ____________________
Check area(s) in which you are skilled/licensed:
Cash Register Calculator Pricing Gun Baler Fork Lift
Stand Up Fork Lift Electric Pallet Jack Manual Pallet Jack RF Scanning Unit Food Scale/Wrapping
CDL Computer Software (list programs): ___________________________________________________
_____________________________________________________________________________________________________________________________
Other skills: ____________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
DG-HRIS-5010-20110705
www.dollargeneral.com
Dollar General
great benefits
offers employees...
a few of the
• Vacation (full-time employees)
• Cash bonus for eligible positions
• 401(k) Savings and Retirement Plan
• Health insurance for all employees
Date
L
FOR HIRING MANAGER USE ONLY
Assessments:
p Meets Standards
p Does Not Meet Standards
ocation
Dollar General strives to maintain
a safe and drug free environment
by conducting background
checks and drug tests
(as permitted by law).
accommodate the personal needs of our employees
GENERAL
Do you have any relatives employed by Dollar General? Yes No
If yes, please list name(s) and where they work: _______________________________________________________________________
Are you legally authorized to work in the United States and able to demonstrate this by providing appropriate documentation?
Yes No
Will you now or in the future require sponsorship for employment visa status? Yes No
Have you ever been convicted of a crime (other than a minor traffic violation)?
Yes No
Illinois, Connecticut and New York applicants: Please review the Notication and Agreement section before answering the question regarding criminal convictions as you may not be required
to disclose certain information, including sealed, expunged or erased records.
Massachusetts and Philadelphia, PA applicants: Do not answer the following question regarding criminal convictions.
If yes, please explain: _____________________________________________________________________________________________
Candidates who select yes are not automatically disqualified from consideration for employment.
How did you find out about employment opportunities at this location?
Website In-Store Signage Newspaper Employee Walk-In
Agency Career Fair College Recruiting Relative
Employee Referral (Name) ______________________________________ Other (specify) __________________________________________
WORK HISTORY
How many different employers have you worked for in the past 5 years? _____________________________________________
Have you ever been suspended, asked to resign or discharged from any employment? Yes No
If yes, please explain: ________________________________________________________________________________________
Please explain any gaps between employers of 3 months or longer: _________________________________________________
Please list other names under which you worked so that Dollar General can verify your previous employment: ______________
_________________________________________________________________________________________________________
L
ist below all current and past employment, beginning with your most recent.
Industry Types:
Use the following 2-digit codes to indicate the type of industry for each job listed in the work history.
01 RETAIL STORE, 02 GROCERY, 03 RESTAURANT, 04 BANKING,
05 REAL ESTATE, 06 TRANSPORTATION, 07 CONSTRUCTION, 08 DISTRIBUTION, 09 MANUFACTURING, 10 PHARMACEUTICAL, 11 WHOLESALE DISTRIBUTION, 12 OTHER
WORK REFERENCES Include current and accurate contact information. Do not include “personal” references.
Name Phone
( ) –
Alternate Phone
( ) –
Years Acquainted
Dollar General is a leading retailer with over 9,000 stores and distribution
centers across the United States with a focus on Serving Others...
DG-HRIS-5010-20110705
An
Equa l
Opp ortunity
Employer
Full Name
Location
Address Email address Occupation/Work Relationship
Name Phone
( ) –
Alternate Phone
( ) –
Years Acquainted
Address Email address Occupation/Work Relationship
Name Phone
( ) –
Alternate Phone
( ) –
Years Acquainted
Address Email address Occupation/Work Relationship
Company Name Industry Type Supervisor Name May we contact this employer?
Address Phone Employed From Employed To
Starting Job Title Ending Job Title Reason for Leaving Pay Rate Start Pay Rate Last
Describe Your Work What did you like best What did you like least
Company Name Industry Type Supervisor Name May we contact this employer?
Address Phone Employed From Employed To
Starting Job Title Ending Job Title Reason for Leaving Pay Rate Start Pay Rate Last
Describe Your Work What did you like best What did you like least
Company Name Industry Type Supervisor Name May we contact this employer?
Address Phone Employed From Employed To
Starting Job Title Ending Job Title Reason for Leaving Pay Rate Start Pay Rate Last
Describe Your Work What did you like best What did you like least
Company Name Industry Type Supervisor Name May we contact this employer?
Address Phone Employed From Employed To
Starting Job Title Ending Job Title Reason for Leaving Pay Rate Start Pay Rate Last
Describe Your Work What did you like best What did you like least
NOTIFIC ATION AND AGREEM ENT
I certify that all information provided by me is true, accurate and complete. I understand that falsification, misrepresentation or omission of fact on this
application or any other accompanying or required documents will be cause for denial of employment or immediate termination of employment, regardless
of how or when it is discovered.
Connecticut applicants: You are not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have been erased
pursuant to Connecticut General Statutes Sections 46-b-146, 54-76o or 54-142a. Criminal records subject to erasure pursuant to the above mentioned statute
sections are records related to (a) determinations of “delinquency” or that, as a child, you were a member of a family with service needs, (b) a ruling you are a
“youthful oender”, (c) a criminal charge that has been dismissed or nulled; (d) a nding you are not guilty for a criminal charge, or (e) a conviction for which
you have received an “absolute pardon”. Any person whose criminal records have been erased pursuant to Connecticut General Statutes Sections mentioned
above shall be deemed to never have been arrested within the meaning of the general statutes with respect to the proceedings so erased and may so swear
under oath.
Illinois applicants: You are not obligated to disclose sealed or expunged records.
New York applicants: You are not required to disclose prior arrests that were resolved in your favor, sealed records, or youthful oender adjudications.
I authorize the investigation of all statements and information contained in this application. I r
elease from all liability anyone supplying such information, and
I also release the employer from all liability that might result from conducting an investigation.
I understand that this application will remain active for a 90 day period. After that time, if I desire further consideration, I will complete a new application in
person or by mail.
Hiring is conditional upon, among other things, a candidate and/or employee submitting proof of identity and work eligibility in accordance with the
Immigration Reform and Control Act, completing and obtaining successful results on a drug screen (if applicable) and criminal background check.
Y
ou must be at least 18 years old to work for Dollar General, unless otherwise authorized by Human Resources or required by law. Close relatives
may not work in the same store or department. No employee may work under the immediate supervision of a close relative. If you have questions
regarding what c
onstitutes a “close relative”, please contact a manager.
UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR
CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS
PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
_______________________________________________________________ _______________
Signature Date
Dollar General does not discriminate on the basis
of race, sex (including pregnancy, childbirth and
related medical conditions), religion, color, age, national
origin, disability, citizenship status, sexual orientation,
genetic information or any other characteristic protected by law.
I understand that this application is not a contract, offer, or promise of employment. I understand that unless otherwise agreed in writing signed by an officer of
the Company and subject to applicable law, Dollar General employees are not hired for a specific term, and Dollar General or I may terminate my employment at
any time with or without cause. No oral representations made by a Dollar General employee with respect to continued employment can alter this relationship.
