Form No 2506 – Fill Out and Use This PDF

APPLICATION FOR EMPLOYMENT

We Are An Equal Opportunity Employer

Committed To Diversity In The Workplace

PERSONAL DATA

NAME

LAST

FIRST

MIDDLE

DATE

PRESENT ADDRESS

(STREET, CITY, STATE, ZIP CODE)

PERMANENT ADDRESS

(IF DIFFERENT FROM ABOVE)

HOME PHONE

BUSINESS PHONE

SOCIAL SECURITY NUMBER

ARE YOU LEGALLY

ARE YOU 16 OR

HAVE YOU EVER BEEN CONVICTED OF A CRIME?* (ANSWERING YES TO THIS QUESTION WILL NOT

AUTHORIZED OR

OVER?

BE AN ABSOLUTE BAR TO AN OFFER OF EMPLOYMENT.)

PERMITTED TO

YES

NO

YES

NO

IF YES, EXPLAIN

WORK IN THE

(IF UNDER 18, A

UNITED STATES?

WORK PERMIT IS

YES

NO

REQUIRED, EXCEPT

*CALIFORNIA AND ILLINOIS APPLICANTS: PLEASE READ THE “NOTICE TO APPLICANTS”

IN AZ, IL, ND, SC,

SECTION ON THE REVERSE SIDE OF THIS APPLICATION PRIOR TO ANSWERING THIS QUESTION.

SD, VA, VT, WV)

PLACEMENT INFORMATION

POSITION OR TYPE OF WORK DESIRED

ARE YOU INTERESTED IN:

FULL TIME

PART TIME

SEASONAL/TEMP.

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

HOURS

AM

AVAILABLE

TO WORK

PM

SALARY OR WAGE DESIRED

DATE AVAILABLE

WHO OR WHAT REFERRED YOU TO BARNES & NOBLE, INC.?

HAVE YOU EVER BEEN EMPLOYED BY ANY OPERATING COMPANY OF BARNES & NOBLE, INC. BEFORE?

YES

NO

IF YES, WHEN AND WHERE

SKILLS: CHECK THE BOXES WHICH APPLY TO YOUR EXPERIENCE.

TYPING

WPM

DATA ENTRY

KPH

ADDING MACHINE

PERSONAL COMPUTER

LOTUS

MS WORD

EXCEL

ACCESS

OTHER

EDUCATION RECORD

LIST LAST HIGH SCHOOL AND ALL BUSINESS, TRADE SCHOOLS AND COLLEGES ATTENDED

EXTRACURRICULAR ACTIVITIES (INCLUDE OFFICES HELD, SCHOLARSHIPS, AWARDS, HONORS, SPORTS, ETC.) YOU ARE NOT REQUIRED TO LIST ACTIVITIES WHICH MAY REVEAL YOUR RACE, RELIGION, SEX, OR NATIONAL ORIGIN.

BARNES & NOBLE, INC. DOES NOT DISCRIMINATE IN HIRING OR TERMS OR CONDITIONS OF EMPLOYMENT ON THE BASIS OF AGE, SEX, RACE, COLOR, CREED, ANCESTRY, RELIGION, DISABILITY, NATIONAL ORIGIN, CITIZENSHIP STATUS, VETERAN STATUS, MARITAL STATUS, MILITARY STATUS, SEXUAL ORIENTATION, PREGNANCY, MEDICAL CONDITION OR ANY NON-JOB OR NON-BUSINESS RELATED FACTORS OR ANY OTHER BASIS UPON WHICH DISCRIMINATION IS PROHIBITED BY THE MUNICIPAL, STATE, OR OTHER FEDERAL LAW. NO QUESTION ON THIS APPLICATION IS INTENDED TO SECURE INFORMATION TO BE USED FOR SUCH DISCRIMINATION.

Form No. 2506 (4/04)

EMPLOYMENT HISTORY

LIST ALL EMPLOYERS WITH CURRENT OR MOST RECENT EMPLOYMENT FIRST. LEAVE NO TIME UNACCOUNTED FOR. IF LIMITED PREVIOUS EMPLOYMENT, LIST THREE PERSONS, NOT RELATED, WHO HAVE KNOWN YOU FOR SOME TIME.

REASON FOR LEAVING OR SEEKING CHANGE OF POSITION

REASON FOR LEAVING

MAY WE CONTACT YOUR CURRENT EMPLOYER? YESNOPHONE ( )

OCCUPATIONAL REFERENCES

(LIST PERSONAL REFERENCES ONLY IF YOU HAVE NO OCCUPATIONAL REFERENCES)

	CHECK ONE		NAME	OCCUPATION	YEARS ACQUAINTED
		OCCUPATIONAL REF.
		PERSONAL REFERENCE
	ADDRESS (STREET, CITY, STATE, ZIP CODE)				TELEPHONE NUMBER
					(	)
	CHECK ONE		NAME	OCCUPATION	YEARS ACQUAINTED
		OCCUPATIONAL REF.
		PERSONAL REFERENCE
	ADDRESS (STREET, CITY, STATE, ZIP CODE)				TELEPHONE NUMBER
					(	)

IN ORDER FOR BARNES & NOBLE, INC. TO CONDUCT REFERENCE CHECKS, PLEASE LIST ANY OTHER NAME YOU HAVE WORKED UNDER.

IMPORTANT, READ BEFORE SIGNING

The filing of an application with Barnes & Noble, Inc. is a preliminary step to employment. It does not obligate Barnes & Noble, Inc. to offer employment, or the applicant to accept employment. An offer of employment, if made, is for employment at will and is not to be construed as a guarantee of continued employment. Barnes & Noble, Inc. reserves the right to terminate the employment of any employee at any time. Any employee also has the right to terminate his or her employment with Barnes & Noble, Inc. at any time.

•I authorize investigation of all matters contained in this application which Barnes & Noble, Inc. may deem relevant to my employment and authorize my previous employers or other persons having information concerning me or my record to report such information to Barnes & Noble, Inc. and such persons are hereby released from all liability for issuing such information. Barnes & Noble, Inc. will keep all such information confidential except where such information is required to be released by law or order of a court or other authority. I understand and agree that I will be subject to immediate dismissal if it is subsequently discovered that the information herein is untrue or that I have failed to disclose a material fact. I understand that if employed by Barnes & Noble, Inc., such employment will occur at will and no contract of employment, expressed or implied, is created and that no representative of Barnes & Noble, Inc. has any authority to enter into any agreement for employment of any specified period of time, or to make any agreement contrary to the foregoing. I understand that if I receive an offer of employment and I accept the position, I will be required to complete additional information necessary for company record keeping requirements.

•NOTICE TO APPLICANTS AS REQUIRED BY THE FAIR CREDIT REPORTING ACT

As part of our employment process, an investigative consumer report, as governed by the Fair Credit Reporting Act or any similar state or local statute, may be requested. However, requests will not be made without your prior written authorization.

•NOTICE TO APPLICANTS IN MASSACHUSETTS

IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.

•NOTICE TO APPLICANTS IN MARYLAND

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 LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

•NOTICE TO APPLICANTS IN CALIFORNIA

IN ANSWERING THIS QUESTION DO NOT INCLUDE: INFORMATION REGARDING AN ARREST OR DETENTION THAT DID NOT RESULT IN CONVICTION; INFORMATION REGARDING REFERRAL TO, AND PARTICIPATION IN, ANY PRE-TRIAL OR POST-TRIAL DIVERSION PROGRAM; MINOR TRAFFIC VIOLATIONS; CONVICTIONS FOR WHICH THE RECORD HAS BEEN JUDICIALLY ORDERED, SEALED OR EXPUNGED; MARIJUANA-RELATED CONVICTIONS DESCRIBED IN CALIFORNIA LABOR CODE SECTION 432.8 THAT ARE MORE THAN TWO YEARS OLD; MISDEMEANOR CONVICTIONS FOR WHICH PROBATION HAS BEEN SUCCESSFULLY COMPLETED OR DISCHARGED AND THAT HAVE BEEN JUDICIALLY DISMISSED PURSUANT TO CALIFORNIA PENAL CODE SECTION 1203.4.

•NOTICE TO APPLICANTS IN ILLINOIS

UNDER ILLINOIS LAW, AN APPLICANT IS NOT OBLIGATED TO DISCLOSE SEALED OR EXPUNGED RECORDS OF CONVICTION OR ARREST.

SIGNATURE

DATE