Lots Job Application Form PDF Details

In today's economy, finding a job can be challenging. That's why it's important to use every tool at your disposal, including the Lots Job Application Form. This form is an easy way to apply for jobs online. You can submit your resume, cover letter, and other documents right from the form. Plus, you can save your application so you can come back to it later.

The listing includes details about the lots job application form. There, you will get the information regarding the PDF you want to fill in, including the assumed time for you to complete it and other details.

QuestionAnswer
Form NameLots Job Application Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesapplication big lots, big lots application online, lots employment, big lots job application pdf

Form Preview Example

BIG LOTS

EMPLOYMENT APPLICATION

This application is considered active for ninety (90) days.

PERSONAL DATA

Please complete in ink.

DRUG-FREE WORKPLACE

All employees are subject to drug and alcohol testing procedures permitted under federal and state law.

WOTC Registration #

Name (Last, First, Middle)

 

 

 

 

 

 

 

Contact Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

Zip

 

E-mail Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position(s) interested in?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salary Requirements

 

 

 

 

 

Are you under the age of 18?

Yes

No

 

 

 

 

 

 

 

 

 

Hour/Year

(Circle One)

 

If yes, state your age.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever worked for Big Lots before?

 

Yes

No

 

 

 

 

 

 

 

If yes, when and where?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If hired, can you supply proof that you are legally entitled to work in the United States for any employer?

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

Do you have friends or relatives working for us?

 

Yes

No

 

 

 

 

 

 

 

If so, who?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Can you work:

Anytime

Days

Evenings

Weekends

 

 

 

 

Are there any times or days you cannot work?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever been convicted of (1) a violent crime (i.e., assault, battery, murder, etc.), (2) a retail related crime (i.e., shoplifting, credit card fraud, robbery, theft,

burglary, etc.), or (3) drug trafficking/distribution?

 

Yes

No

 

 

 

 

 

 

 

Note: A “yes” response will not automatically disqualify you from employment, but will be considered as part of your overall job-related qualifications for

employment. You do not need to disclose any information regarding arrests or any criminal charges and/or convictions that have been erased, annulled, sealed

and/or expunged from your record.

 

 

 

 

 

 

 

 

 

 

 

If yes, please describe:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EDUCATION

Type of School

Name of School

Location of School

Area of Study

Last Year

Did You Earn a

Completed

Degree or Diploma?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

High School

 

 

 

1

2

3

4

Yes

No

 

 

 

 

 

 

 

 

 

 

College

 

 

 

1

2

3

4

Yes

No

 

 

 

 

 

 

 

 

 

 

Graduate

 

 

 

1

2

3

4

Yes

No

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

1

2

3

4

Yes

No

 

 

 

 

 

 

 

 

 

 

REFERENCES

List names of three people (other than relatives) we may contact who have knowledge of your job-related skills.

1

2

3

Name

Telephone Contact/E-mail Contact

Address/City/State

Occupation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AN EQUAL OPPORTUNITY EMPLOYER

CONTINUED ON BACK

 

Big Lots is an Equal Opportunity Employer and does not discriminate in making employment decisions based upon race,

color, sex, religion, national origin, age, disability, marital status, sexual orientation, or veteran or military status.

SOS SKU# 960600043 • 08/12

EMPLOYMENT HISTORY

BEGINNING WITH YOUR MOST RECENT EMPLOYER, LIST ALL EMPLOYMENT INCLUDING MILITARY SERVICE AND SELF-EMPLOYMENT. Please account for all periods of unemployment. All sections of this application must be complete even if a resume is attached.

If presently employed, may we contact your employer for references?

Yes

No May we contact you at your place of employment?

Yes

No

Name of present or last employer

Job Title/Responsibilities

 

 

From (Mo. & Yr.)

To (Mo. & Yr.)

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

Supervisor Name

 

 

 

Was your position

Full time

Part time

 

 

 

 

 

 

 

 

 

 

 

City, State, ZIP

 

 

Reason for leaving

Terminated

Voluntary

Involuntary

Starting Salary $

 

 

 

Explain

 

 

 

 

 

 

 

 

 

 

 

 

Last Salary $

 

Phone Number

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of previous employer

 

Job Title/Responsibilities

 

 

From (Mo. & Yr.)

To (Mo. & Yr.)

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

Supervisor Name

 

 

 

Was your position

Full time

Part time

 

 

 

 

 

 

 

 

 

 

City, State, ZIP

 

 

Reason for leaving

Terminated

Voluntary

Involuntary

Starting Salary $

 

 

 

Explain

 

 

 

 

 

 

 

 

 

 

 

 

Last Salary $

 

Phone Number

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of previous employer

 

Job Title/Responsibilities

 

 

From (Mo. & Yr.)

To (Mo. & Yr.)

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

Supervisor Name

 

 

 

Was your position

Full time

Part time

 

 

 

 

 

 

 

 

 

 

City, State, ZIP

 

 

Reason for leaving

Terminated

Voluntary

Involuntary

Starting Salary $

 

 

 

Explain

 

 

 

 

 

 

 

 

 

 

 

 

Last Salary $

 

Phone Number

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of previous employer

 

Job Title/Responsibilities

 

 

From (Mo. & Yr.)

To (Mo. & Yr.)

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

Supervisor Name

 

 

 

Was your position

Full time

Part time

 

 

 

 

 

 

 

 

 

 

City, State, ZIP

 

 

Reason for leaving

Terminated

Voluntary

Involuntary

Starting Salary $

 

 

 

Explain

 

 

 

 

 

 

 

 

 

 

 

 

Last Salary $

 

Phone Number

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of previous employer

 

Job Title/Responsibilities

 

 

From (Mo. & Yr.)

To (Mo. & Yr.)

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

Supervisor Name

 

 

 

Was your position

Full time

Part time

 

 

 

 

 

 

 

 

 

 

City, State, ZIP

 

 

Reason for leaving

Terminated

Voluntary

Involuntary

Starting Salary $

 

 

 

Explain

 

 

 

 

 

 

 

 

 

 

 

 

Last Salary $

 

Phone Number

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I understand that Big Lots may contact the past employers and/or personal references I have provided in order to verify my past employment and work record. I authorize all past employers, educational institutions, government agencies and/or personal references to release any and all information concerning my past employment work history, performance, and personal character. I hereby release all such employers, personal references, and Big Lots from any and all liability resulting from damages I may incur in the reference verification process. I understand that my employment or continued employment is contingent upon my successfully completing both reference and background checks.

I also understand that if employed by Big Lots, my employment is “at will” and can be terminated at any time for any reason either by myself or the Company. This agreement cannot be modified by any representative of the Company either in writing or verbally.

Finally, I understand it is unlawful for Big Lots to employ anyone who is neither a citizen of the U.S. nor an alien authorized to work in the U.S. I certify

that any U.S. citizenship/work authorization information I provide to the Company is authentic. Further, I certify that all information I have provided on this application is accurate.

False information or omission of facts on this application may result in the termination of my employment with Big Lots.

Applicant’s Signature

Date

Thank you for your interest and the time you have taken to submit this application.

Form 8850 (Rev. January 2012)

Department of the Treasury Internal Revenue Service

Pre-Screening Notice and Certification Request for

the Work Opportunity Credit

See separate instructions.

OMB No. 1545-1500

Job applicant: Fill in the lines below and check any boxes that apply. Complete only this side.

Your name

 

Social security number

Street address where you live

City or town, state, and ZIP code

County

 

Telephone number

 

 

 

If you are under age 40, enter your date of birth (month, day, year)

1

2

3

4

5

6

Check here if you received a conditional certification from the state workforce agency (SWA) or a participating local agency for the work opportunity credit.

Check here if any of the following statements apply to you.

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 Veterans 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 past 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 supplemental security income (SSI) benefits for any month ending during the past 60 days.

I am a veteran and I was unemployed for a period or periods totaling at least 4 weeks but less than 6 months during the past year.

Check here if you are a veteran and you were unemployed for a period or periods totaling at least 6 months during the past year.

Check here if you are a veteran entitled to compensation for a service-connected disability and you were discharged or released from active duty in the U.S. Armed Forces during the past year.

Check here if you are a veteran entitled to compensation for a service-connected disability and you were unemployed for a period or periods totaling at least 6 months during the past year.

Check here if you are a member of a family that:

Received TANF 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.

Signature—All Applicants Must Sign

Under penalties of perjury, I declare that I gave the above information to the employer on or before the day I was offered a job, and it is, to the best of my knowledge, true, correct, and complete.

Job applicant’s signature

Date

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Cat. No. 22851L

Form 8850 (Rev. 1-2012)

Form 8850 (Rev. 1-2012)

 

 

 

 

 

 

 

Page 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For Employer’s Use Only

 

 

 

 

Employer’s name

 

 

Telephone no.

 

EIN

 

 

 

 

 

 

 

 

 

 

 

Street address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City or town, state, and ZIP code

 

 

 

 

 

 

 

 

 

 

 

 

 

Person to contact, if different from above Phil Ownbey c/o First Advantage

Telephone no. (888) 570-4455

 

 

 

 

 

 

Street address 9800 Crosspoint Boulevard, Suite 300

 

 

 

 

 

 

 

 

 

 

 

City or town, state, and ZIP code

Indianapolis, IN 46256

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If, based on the individual’s age and home address, he or she is a member of group 4 or 6 (as described under Members of Targeted Groups in the separate instructions), enter that group number (4 or 6) . . . . . . . . . . . . . .

Date applicant:

 

 

 

 

 

 

Gave

 

Was

 

Was

 

Started

information

 

offered job

 

hired

 

job

 

 

 

 

 

 

 

Under penalties of perjury, I declare that the applicant provided the information on this form on or before the day a job was offered to the applicant and that the information I have furnished is, to the best of my knowledge, true, correct, and complete. Based on the information the job applicant furnished on page 1, I believe the individual is a member of a targeted group. I hereby request a certification that the individual is a member of a targeted group.

Employer’s signature

Title

 

Date

 

 

 

 

 

Privacy Act and

criminal litigation, to the Department of

The time needed to complete and file

Labor for oversight of the certifications

this form will vary depending on

 

Paperwork Reduction

 

performed by the SWA, and to cities,

individual circumstances. The estimated

Act Notice

states, and the District of Columbia for

average time is:

 

 

 

use in administering their tax laws. We

 

 

 

 

 

Recordkeeping

. .

6 hr., 27 min.

SECTION REFERENCES ARE TO THE INTERNAL

may also disclose this information to

 

 

 

 

REVENUE CODE.

other countries under a tax treaty, to

Learning about the law

 

 

Section 51(d)(13) permits a prospective

federal and state agencies to enforce

or the form . . . .

. .

. 30 min.

federal nontax criminal laws, or to

 

 

 

 

employer to request the applicant to

Preparing and sending this form

federal law enforcement and intelligence

complete this form and give it to the

to the SWA . . . .

. .

. 37 min.

agencies to combat terrorism.

prospective employer. The information

 

 

 

 

 

If you have comments concerning the

will be used by the employer to

You are not required to provide the

accuracy of these time estimates or

complete the employer’s federal tax

information requested on a form that is

suggestions for making this form

return. Completion of this form is

subject to the Paperwork Reduction Act

simpler, we would be happy to hear from

voluntary and may assist members of

unless the form displays a valid OMB

you. You can write to the Internal

targeted groups in securing employment.

control number. Books or records

Revenue Service, Tax Products

 

Routine uses of this form include giving

relating to a form or its instructions must

 

Coordinating Committee,

 

 

it to the state workforce agency (SWA),

be retained as long as their contents

 

 

SE:W:CAR:MP:T:M:S, 1111 Constitution

which will contact appropriate sources

may become material in the

Ave. NW, IR-6526, Washington, DC

to confirm that the applicant is a

administration of any Internal Revenue

20224.

 

 

 

member of a targeted group. This form

law. Generally, tax returns and return

 

 

 

 

 

 

 

may also be given to the Internal

information are confidential, as required

Do not send this form to this address.

Revenue Service for administration of

by section 6103.

Instead, see WHEN AND WHERE TO FILE in

the Internal Revenue laws, to the

 

the separate instructions.

 

 

Department of Justice for civil and

 

 

 

 

 

Form 8850 (Rev. 1-2012)

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