Job Application

Education

Work History

Employer One

Employer Two

Willingness Checklist

Part of the activities required to maintain and operate a retail store involve duties or tasks that are often overlooked when
describing a specific job. Please indicate your feelings regarding these tasks and duties by placing an “X” on the
appropriate line.

Would you be willing to:

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete,
and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references, (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organization for furnishing such information about me.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves that same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration.

If hired, I understand that I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I also understand that if I am offered full time employment, I must successfully complete an alcohol/drug screen prior to my hire date.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to 1) eliminate me from further consideration for employment, or 2) may result in my immediate discharge from the employer’s service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.

Electronic Signature

Pre-Employment Drug Testing Consent and Release Form

I hereby consent to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis, as shall be determined by Brown’s Shoe Fit Company in order to meet with their policy regarding the selection of applicants for employment.

I further authorize and give full permission to have Brown’s Shoe Fit Company and/or its authorized agents and physicians to send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the company. I further agree to and hereby authorize the release of the results of said tests to Brown’s Shoe Fit Company.

I understand that it is the current use of illegal drugs that would prohibit me from being employed at Brown’s Shoe Fit Company.

I further agree to hold harmless the Company and its agents and physicians from any liability arising in whole or part, out of the collection of specimens, testing, and use of the information from said testing in connection with the Company's consideration of my application of employment.

I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.

I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.