Fillable Printable Tilly's Application Form

Tilly's Application Form

This application will remain current for a period of 30 days

Please complete this application in your own handwriting, and answer or acknowledge every question

E M PL O Y M E N T A P P L I C A TI O N

– An Equal Opportunity Employer –

“Prospective employees will receive consideration without discrimination because of race, color, creed, sex, marital status, age, national origin

or ancestry, physical or mental disability, medical condition, sexual orientation, or any other consideration made unlawful by federal, state or local laws.”

“We are a drug free workplace”

PE R S O N A L I N F O R M A T I O N

Last Name

First Name

Middle Name

Phone Number (Cell)

Phone Number/E-Mail Address

Present Street Address

City

State

Zip Code

How Long?

Previous Street Address

City

State

Zip Code

How Long?

Are you at least 18 years old?

Yes No

Are you at least 16 years old?

Yes No

If you are under 18, you will be

required to obtain a work permit

based on State/Local law.

Are you legally eligible for

employment in this country?

Yes No

Proof of U.S. citizenship or

immigration status will be

required upon employment.

Have you ever been convicted of a felony or misdemeanor?

(A conviction may be relevant if job related, but not necessarily bar you from employment.)

Yes No If yes, please explain:_______________________

(CA Applicants: Excluding marijuana convictions older than two years.)

Have you ever been terminated or asked to resign from any job?

Yes No If yes, please explain:_______________________

J O B I NT E R E S T & A V A I L A B I L I T Y

Position

Applying For:

Schedule

Desired:

Weekly Hours Worked,

At Your Previous Jobs:

Days & Hours You Are Available

Per Work Week:

Daily Driving

Distance:

Store

Management

Sales

Other_________



Corporate

_____________

Distribution Center

_____________

Full Time

Part Time

Seasonal

Internship

1._________ Hours

2._________ Hours

3._________ Hours

4._________ Hours

Maximum Hours You

Are Willing To Work

Per Week:_________

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

________ To _______

If required by the

job, would you

be willing to

commute?

Yes No

If “Yes”, How Far?

______ Miles.

Based on your understanding of the duties of the job you are applying for, are you able to perform these duties with or without

accommodation?  Without accommodation  With accommodation

If you will need accommodation, please specify below:

____________________________________________________________________________________________________

Has TiLLY’S ever

employed you?

Yes No

If “Yes” when? _____

Available

Starting Date:

Salary Desired:

List names of friends or relatives

employed by TiLLY’S, now, or in the

past:

How did you learn of this

opening?

E D U C A T I O N A L B A C K G R O U N D

Type Of School

Name & Location Of School

Major /

Area Of Study

Number Of Years

Attended

Graduated

(Check One)

High School

Yes No



College

Yes No



Graduate School

Yes No



Other

Yes No



S KI L L S & Q U A L I F I C A T I O N S

Summarize special skills and qualifications acquired from employment, membership in professional organizations or other experiences that may qualify you for work with TiLLY’S.

Exclude those, which indicate race, color, religion, sex, national origin, ancestry, age, physical or mental disability, medical condition, sexual orientation or marital status.

E M P L O Y M E N T H I S T O R Y

List employment starting with the most recent position. Account for any time during this period that you were unemployed by stating the nature of your

activities. If you have less than four places of employment, please include personal references to be contacted. If you have more than four places of

employment, please list on a separate piece of paper.

Name And Address of Company & Type of Business:

FROM

Describe The Work You Did:

MO.

YR.

MO.

YR.

Ending Salary:

Job Title:

Reason For Leaving:

Phone Number:

Name Of Supervisor:

May This Company Be Contacted For References?

Name And Address of Company & Type of Business:

FROM

Describe The Work You Did:

MO.

YR.

MO.

YR.

Ending Salary:

Job Title:

Reason For Leaving:

Phone Number:

Name Of Supervisor:

May This Company Be Contacted For References?

Name And Address of Company & Type of Business:

FROM

Describe The Work You Did:

MO.

YR.

MO.

YR.

Ending Salary:

Job Title:

Reason For Leaving:

Phone Number:

Name Of Supervisor:

May This Company Be Contacted For References?

Name And Address of Company & Type of Business:

FROM

Describe The Work You Did:

MO.

YR.

MO.

YR.

Ending Salary:

Job Title:

Reason For Leaving:

Phone Number:

Name Of Supervisor:

May This Company Be Contacted For References?

PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH AND SIGN BELOW

____ I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and

correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that omission or

misstatement of material fact on this application or any other document used to secure employment shall be grounds for rejection of this application or for immediate

discharge if I am employed, regardless of the time elapsed before discovery.

____ I hereby authorize TiLLY’S to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize

the references I have listed to disclose to TiLLY’S any and all letters, reports and other information related to my work records, without giving me prior notice of such

disclosure. In addition, I hereby release TiLLY’S, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands

or liabilities arising out of or in any way related to such investigation or disclosure.

____ I understand that nothing that contains in the application, or conveyed during any interview, which may be granted, or during my employment, if hired, is intended to create an

employment contract between Tilly’s and me. I understand that, if hired, I may be transferred, reassigned, suspended or demoted. In addition, I understand and agree that if

I am employed, my employment will be At-Will and is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of

either myself or Tilly’s, and that no promises or representations contrary to the foregoing are binding on Tilly’s unless made in writing and signed by me and Tilly’s designated

representatives (Tilly’s CEO or CFO and Director of Human Resources).

____ I hereby agree that in the event of any dispute arising out of submission of this application or my employment with Tilly's (except for workers' compensation claims and

unemployment insurance), I and TiLLY’S agree to first try in good faith to settle the dispute by mediation administered by a member of the American Arbitration Association

or other mutually agreed upon mediator. The party seeking dispute resolution must provide the other party with a detailed description of the grievance, the facts supporting

the grievance and the amount sought at least 30 days before commencing mediation proceedings. TiLLY’S agrees to pay the cost of the mediation.

Date: __________ Applicant’s Name: _________________________________ Applicant’s Signature: __________________________

FOR OFFICE USE ONLY ! DO NOT WRITE BELOW THIS LINE !

Interviewed By: ______________________ Date: ___________ Hired: Yes No Job Title: ___________________________

Location: __________ Salary / Wages: ________________ FT PT  Seasonal Date Reporting To Work:________________

RSC USE ONLY

Hours: ___________ Comments:__________________________________________________________________________________