Sample Application Form Vivo Online Employment Application Full Name: Address: City: State/Province: Zip/Postal Code: Primary Phone: Secondary Phone: When can you start? Positions Applied for: Team Member Team Leader Assistant Team Leader Are you legally authorized to work in the US? No Yes How did you hear about this position? Availability: Full or Part-Time Full Time Part-Time Have you worked for Vivo before? If yes, when and where? List any relatives or friends employed by Vivo, their position & location. Do you have a valid drivers license? No Yes Have you ever been convicted of a felony crime or theft related misdemeanor? No Yes Education High School Name of school and mailing address: Number of years completed: Major or Degree: College Bus. or Trade School Name of school and mailing address: Number of years completed: Major or Degree: Professional School Name of school and mailing address: Number of years completed: Major or Degree: Other Name of school and mailing address: Number of years completed: Major or Degree: Employment History Please provide recent history for you last three employers. 1. Employer Name (Most Recent): Name of last supervisor: Employment start date: Employment end date: Employers Address: Phone Number: Last job title: Reason for leaving (be specific): List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company: May we contact your employer: Yes No Is there anything else you would like to share about this employment experience? Employment History 2. Employer Name: Name of Supervisor: Start Date: End Date: Employer's Address: Phone number: Job title: Reason for leaving (be specific): List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company: May we contact your employer: Yes No Is there anything else you would like to share about this employment experience? Employment History 3. Employer Name: Name of Supervisor: Start Date: End Date: Employer's Address: Phone number: Job title: Reason for leaving (be specific): List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company: May we contact your employer: Yes No Is there anything else you would like to share about this employment experience? References Please list 2 references other than relatives and previous employers 1. Name: Position: Company: Telephone 2. Name: Position: Company: Telephone: Have you ever shopped at Vivo before? If so, where? Who do you most admire and why? Where do you see yourself in 5 years? What kind of music do you listen to? What activities or hobbies are you involved in? What virtues do you admire most in others and why? Why do you like working in retail? I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment, including current and past employment, education, background history and criminal history. I hereby expressly release from liability all persons, companies, corporations, and schools supplying information. I understand and authorize background checks on employment, education, references and criminal history. I understand that upon my written request, I will be informed whether a criminal report was sought and if used in my employment decision, I will receive a copy of the criminal report. I acknowledge that a fax or photocopy of this release shall be as valid as the original. I hereby authorize, without reservation, any laws any time in writing. Such written revocation is not valid until received by the Vivo Human Resource Director. I hereby understand that any employment relations with Vivo is "at-will", which means that the employee may resign at any time and the employer may discharge employee at any time with or without cause. It is further understood that "at-will" employment or any other agreement involving Vivo may not be changed unless specifically acknowledged in writing by Vivo's President. In the event of employment, I understand that any falsification or omission of information given in my application or interview(s) is immediate grounds for dismissal. I also understand that I am required to abide by all rules and regulations of Vivo. I understand and agree that Vivo corporate office is located in Idaho and that Idaho law is the governing law for the application, hiring and employment process. I hereby agree to the use of electronic records and electronic signatures for any transactions with Vivo that may require my signature. Please enter your name and email address below to confirm that you that you agree to these terms and conditions. Full Name: Email Address: