EMPLOYMENT APPLICATION
Name
Kohl’s Department Stores is an Equal Employment Opportunity Employer and gives all applicants for employment equal consideration regardless of race, color, sex, religion, national origin, ancestry, age, physical or mental disability, sexual orientation, transgender status, genetic information, marital status, citizenship status, veteran status, pregnancy, height, weight, or any other status protected by federal, state or local law. Upon request and consistent with applicable laws, Kohl’s will provide reasonable accommodations to individuals with disabilities who need an accommodation to fully participate in the application process.
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AVAILABLE TO WORK: |
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Have you ever applied at or been employed by Kohl’s before?If yes, please give dates & location
Have you ever worked for Kohl’s in the capacity of a temporary employee and/or contracted employee? _______________ If yes, please explain. __________________________
Are you legally entitled to work in the United States? |
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If hired, can you provide documentation of this eligibility? |
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Are you 18 years of age or older?_______________ If no, state your age _________________ |
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Do you have any friends or relatives employed by Kohl’s? |
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If yes, give names and locations |
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Employment History – First list all current employment, then list all previous employment. |
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Please explain all periods of unemployment:
We conduct pre-employment drug screening for some positions. Are you willing to submit to a drug test? |
Yes_______ No _______ |
BEFORE ANSWERING THE FOLLOWING QUESTIONS, PLEASE REFER TO THE INSTRUCTIONS THAT FOLLOW IF YOU ARE APPLYING FOR A POSITION IN CALIFORNIA, CONNECTICUT, ILLINOIS, MASSACHUSETTS, NEW YORK, UTAH, or WASHINGTON.
Have you ever been convicted of or plead guilty to a crime? (Answer NO for any annulled, expunged or sealed records; minor traffic offenses; or any conviction that was pardoned, discharged, or dismissed upon condition of probation).
Yes _____ No _______
If you checked “Yes,” please explain below. A criminal conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe the nature of the crime and your subsequent rehabilitation.
If yes, provide details__________________________________________________________________________________________________________________________________________________________________
INSTRUCTIONS - CRIMINAL CONVICTIONS QUESTIONS
California Applicants: You may answer “No Record” with respect to any conviction for a marijuana offense if the conviction occurred more than two years prior to the date this application is completed. In addition, do not provide any information regarding a referral to and participation in any pre-trial or post-trial diversion program.
Connecticut Applicants: You are not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have been erased. Conn.Gen.Stat. Sections 46b-146, 54-76o or 54-142a. Criminal records subject to erasure pursuant to Conn.Gen.Stat. Sections 46b-146, 54-76o or 54-142a 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 offender”, (c) a finding you are not guilty for a criminal charge, or (d) a conviction for which you have received an “absolute pardon”. Any person whose criminal records have been erased pursuant to Conn. Gen.Stat. Sections 46b-146, 54-76o or 54-142a 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 required to reveal any expunged convictions, including expunged juvenile convictions.
Massachusetts / City of Philadelphia Applicants: In Massachusetts and the City of Philadelphia only, DO NOT answer YES OR NO or provide any information of your criminal history.
New York Applicants: You may answer “No Record” with respect to any youthful offender conviction.
Utah Applicants: You may answer “No Record” with respect to any conviction for a misdemeanor or summary offense.
Washington Applicants: Answer “Yes” only if the conviction or release from imprisonment was within the last ten (10) years, or related to the functions of the position for which you are applying.
ADDITIONAL STATE INFORMATION
Maryland / Massachusetts Applicants: It is unlawful for an employer to require or demand as a condition of employment, prospective employment, or continued employment, that any individual submit to or take a lie detector or similar tests. An employer who violates the law is subject to criminal penalties and fines.
Rhode Island Applicants: Kohl’s is subject to Chapters 29-38 of Title 28 of the General Laws of Rhode Island and is therefore covered by the state’s workers’ compensation law.
APPLICANT’S STATEMENT
I have read and fully understand the questions asked in this application. I certify that all of the answers I have given are true, accurate and complete. I understand that the omission and/or misrepresentation of any fact from or on this application or during any interview will result in immediate rejection of my application or if I am hired will be cause for immediate dismissal. Unless I noted otherwise, I authorize the Company to contact all my employment references and personal references, as well as the education institutions I have attended. I further authorize the Company to inquire about, investigate and obtain copies of any records which relate to me from my former employers and educational institutions. I hereby release Kohl’s and all affiliated persons and entities, as well as any person or institution that provides Kohl’s with any lawful information about me, from any and all liability whatsoever resulting from any such lawful inquiry, investigation or communication.
If hired, I agree to abide by all of the rules and regulations of the Company. I understand and agree that nothing in this application shall constitute an offer, a contract or a guarantee of employment for a specific period of time. If hired, I understand that my employment is at-will and may be terminated with or without cause and with or without notice at any time, at the option of either Kohl’s or myself. I further understand that no representative or agent of the Company, other than the Senior Vice President of Human Resources, has the authority to enter into any agreement for employment for any specific period of time, or to make an agreement contrary to the foregoing. I also understand that any agreement modifying my at-will employment status must be in writing and signed by the Senior Vice President of Human Resources. In addition, I understand that the Company and all plan administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms and conditions of employment. I understand that any hiring decision is contingent upon my successful completion of all of the Company's lawful pre-employment checks, which may include a background check. I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment checks.
Signature ___________________________________________________ |
Date____________________________________ |
AR-017E 07/2011
Applicant Notification
Work Opportunity Tax Credit Program
Kohl’s participates in the Work Opportunity Tax Credit program. This program is designed by the federal government to help companies hire more people into the workforce and to retain employees through federal incentives.
If hired, you will be asked to complete a survey during orientation based on the criteria below, which will help our tax credit consultant determine if Kohl's qualifies for this program. Thank you in advance for your time and participation.
Please read the following statement (note - some or all statements may not apply):
Work Opportunity Tax Credit categories:
§I am a member of a family that has received assistance from Temporary Assistance for Needy Families (TANF) for any 9 months during the past 18 months.
§I am a veteran and a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps) for at least a 3-month period during the past 15 months.
§I was referred here by a rehabilitation agency approved by the state, an employment network under the Ticket to Work program or the Department of Veteran Affairs.
§I am at least age 18 but not age 40 or older, and I am a member of a family that:
a.Received SNAP benefits (food stamps) for the past 6 months, or
b.Received SNAP benefits (food stamps) for at least 3 of the 5 months, but is no longer eligible to receive them.
§During the past year, I was convicted of a felony or released from prison for a felony.
§I received supplement security income (SSI) benefits for any month ending during the past 60 days.
§I am a veteran and I was discharged or released from active duty in the U.S. Armed Forces during the past 5 years and, for at least 4 weeks during the past year, I received unemployment compensation.
§I am at least age 16 but not age 25 or older, and:
a. During the past 6 months, I have not attended a secondary, technical, or post-secondary school for more than an |
average of 10 hours per week, not |
counting periods during which the school was closed for scheduled vacations, and |
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b.During the past 6 months, if I was employed, during each consecutive 3-month period within the past 6 months, I earned less than I would have earned if I had worked for the applicable minimum wage 30 hours every week during the 3-month period, and
c.I do not have a certificate of graduation from a secondary school or a General Education Development (GED) certificate or I have a certificate that was awarded at least 6 months ago and I have not held a job (other than occasionally) or been admitted to a technical or post-secondary school since I received the certificate.
§Discharged or released from active duty in the U.S. Armed Forces, or
§Unemployed for a period or periods totaling at least 6 months.
§Received TANF (temporary assistance for needy family) payments for at least the past 18 months, or
§Received TANF payments for any 18 months beginning after August 5, 1997, and the earliest 18-month period beginning after August 5, 1997, ended during the past 2 years, or
§Stopped being eligible for TANF payments during the past 2 years because federal or state law limited the maximum time those payments could be made.
