Lands' End Employment On-line Application

Lands' End EMPLOYMENT APPLICATION

(PRE-EMPLOYMENT QUESTIONNAIRE) (AN EQUAL OPPORTUNITY EMPLOYER)

Principle 5.

We believe that what is best for our customer is best for all of us. If you were encouraged to apply by a Lands' End employee, please let us know.

Employee's Name:

Employee's dept.:

PERSONAL INFORMATION

DATE:

NAME (Last, First, Middle):

ADDRESS (Street, City, State, Zip Code):

PHONE NO: ARE YOU 18 YEARS OR OLDER? YES NO
*If under 18 years of age, employment is subject to verification of minimum legal age by a work permit.

E-MAIL ADDRESS:

EMPLOYMENT DESIRED

LOCATION: Dodgeville Cross Plains Reedsburg
Outlet:

POSITION:
SHIFT: 1st 2nd 3rd ANY DATE YOU CAN START:
SALARY DESIRED:

ARE YOU EMPLOYED NOW? YES NO IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? YES NO

HAVE YOU EVER APPLIED AT LANDS' END BEFORE? YES NO WHERE? WHEN?

HAVE YOU EVER WORKED AT LANDS' END BEFORE? YES NO WHERE? WHEN?

EDUCATION AND TRAINING

INDICATE THE HIGHEST GRADE/YEAR COMPLETED
1 2 3 4 5 6 7 8 9 10 11 12 NAME & LOCATION OF HIGH SCHOOL:

YEAR GRADUATED: IF NOT A H.S. GRAD, DO YOU HAVE A GED EQUIVALENCY?
YES NO

TRAINING BEYOND HIGH SCHOOL (COLLEGE OR UNIVERSITY, NURSING, BUSINESS COLLEGE, OR OTHER SCHOOLS YOU HAVE ATTENDED.) INDICATE THE NUMBER OF YEARS COMPLETED IN COLLEGE OR UNIVERSITY
1 2 3 4 5 6 7 8

NAME AND LOCATION

DATES ATTENDED

FROM TO

GRADUATED

MAJOR

DEGREE CONFERRED AND YEAR

YES NO

YES NO

YES NO

YES NO

*The age discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are age 40 and older.

DESCRIBE ANY EDUCATION AND TRAINING YOU HAVE HAD WHICH IS NOT COVERED ABOVE, SUCH AS VOCATIONAL SCHOOL, CORRESPONDENCE COURSES, SERVICE SCHOOLS, IN-SERVICE TRAINING, OR VOLUNTEER WORK WHICH YOU FEEL IS RELEVANT TO THE JOB YOU ARE APPLYING FOR. ALSO INCLUDE RELEVANT LICENSES OR CERTIFICATES. BE SPECIFIC AND INCLUDE DATES.

FORMER EMPLOYERS

(List below last 3 employers, starting with last one first.)

DATE
MONTH AND YEAR

NAME AND ADDRESS OF EMPLOYER

POSITION/PAY

REASON FOR LEAVING

From:
To: Employer:
Address/Phone No:
Name of Supervisor:

From:
To: Employer:
Address/Phone No:
Name of Supervisor:

From:
To: Employer:
Address/Phone No:
Name of Supervisor:

HOW WERE YOU REFERRED TO THIS COMPANY?

Newspaper (specify)

Radio Ad (specify)

Employee of Lands' End (name)

Technical College/University (specify)

Other (specify)

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained here in and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is for no difinite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice."

DATE: NAME:

This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. LE is an equal opportunity employer and does not discriminate against applicants on the basis of race, color, sex, religion, national origin, handicap, veteran status, age, sexual orientation, marital status, or any other protected category as required by law.

COMPLETING THIS PART IS VOLUNTARY AND IS NOT A REQUIREMENT FOR EMPLOYMENT:

Various agencies of the United States Government require employers to maintain information on applicants pertaining to factors such as race and sex. The information requested is for the pupose of our compliance with those recordkeeping requirements and to determine recruiting and employment patterns. Lands' End believes all person are entitled to equal employment opportunities and does not discriminate against its employees or applicants because of race, color, sex, religion, national origin, handicap, veteran status, age, or marital status.

RACE: SEX:

White Female

Black Male

Hispanic

Asian or Pacific Islander

American Indian or Alaska Native

Other:

	EMPLOYMENT APPLICATION (PRE-EMPLOYMENT QUESTIONNAIRE) (AN EQUAL OPPORTUNITY EMPLOYER)
Principle 5. We believe that what is best for our customer is best for all of us.	If you were encouraged to apply by a Lands' End employee, please let us know. Employee's Name: Employee's dept.:

INDICATE THE HIGHEST GRADE/YEAR COMPLETED 1 2 3 4 5 6 7 8 9 10 11 12	NAME & LOCATION OF HIGH SCHOOL: YEAR GRADUATED:		IF NOT A H.S. GRAD, DO YOU HAVE A GED EQUIVALENCY? YES NO
TRAINING BEYOND HIGH SCHOOL (COLLEGE OR UNIVERSITY, NURSING, BUSINESS COLLEGE, OR OTHER SCHOOLS YOU HAVE ATTENDED.)		INDICATE THE NUMBER OF YEARS COMPLETED IN COLLEGE OR UNIVERSITY 1 2 3 4 5 6 7 8
NAME AND LOCATION	DATES ATTENDED FROM TO	GRADUATED	MAJOR	DEGREE CONFERRED AND YEAR
		YES NO
		YES NO
		YES NO
		YES NO
*The age discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are age 40 and older.
DESCRIBE ANY EDUCATION AND TRAINING YOU HAVE HAD WHICH IS NOT COVERED ABOVE, SUCH AS VOCATIONAL SCHOOL, CORRESPONDENCE COURSES, SERVICE SCHOOLS, IN-SERVICE TRAINING, OR VOLUNTEER WORK WHICH YOU FEEL IS RELEVANT TO THE JOB YOU ARE APPLYING FOR. ALSO INCLUDE RELEVANT LICENSES OR CERTIFICATES. BE SPECIFIC AND INCLUDE DATES.

DATE MONTH AND YEAR	NAME AND ADDRESS OF EMPLOYER	POSITION/PAY	REASON FOR LEAVING
From: To:	Employer: Address/Phone No: Name of Supervisor:
From: To:	Employer: Address/Phone No: Name of Supervisor:
From: To:	Employer: Address/Phone No: Name of Supervisor: