Tillys Job Application Form – Fill Out and Use This PDF

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 P L O Y M E N T A P P L I C A T I 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”

P E R S O N A L I N F O R M A T I O N

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

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:

____________________________________________________________________________________________________

____________________________________________________________________________________________________

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 /	Number Of Years	Graduated
			Area Of Study	Attended	(Check One)
	High School				Yes	No
					
	College				Yes	No
					
	Graduate School				Yes	No
					
	Other				Yes	No
					

S K I 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.

SS000504

Last Updated: 06/01/2011

© 2011 Tilly’s Clothing, Shoes & Accessories

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				TO			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				TO			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				TO			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				TO			Describe The Work You Did:
	MO.	YR.		MO.			YR.
	Ending Salary:

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:__________________________________________________________________________________
		SS000504	Last Updated: 06/01/2011	© 2011 Tilly’s Clothing, Shoes & Accessories