Dollar Tree, Inc.
APPLICATION FOR EMPLOYMENT

HAVE YOU APPLIED FOR EMPLOYMENT WITH US PREVIOUSLY?
YES

NO -- IF YES...

MONTH & YEAR:
LOCATION:

YES
NO
ARE YOU AVAILABLE FOR FULL TIME WORK?
WHAT DAYS AND HOURS ARE YOU NOT AVAILABLE FOR WORK:
DO YOU HAVE RELATIVES OR FRIENDS WORKING FOR DOLLAR TREE STORES?
IF YES, GIVE NAME, LOCATION & RELATIONSHIP:

YES

NO

SPECIAL TRAINING OR SKILLS (LANGUAGES, MACHINE OPERATION, ETC.)

ARE YOU 18 YEARS OF AGE OR OLDER?

YES

NO

SUBJECT TO VERIFICATION OF MINIMUM LEGAL AGE REQUIREMENTS

REV. 12-2015

EMPLOYMENT HISTORY
(SHADED AREAS FOR COMPANY USE ONLY)

PLEASE GIVE ACCURATE. COMPLETE
FULL-TIME AND PART-TIME EMPLOYMENT
RECORD. START WITH PRESENT OR
MOST RECENT EMPLOYER.

COMPANY NAME:

TELEPHONE:

ADDRESS:

EMPLOYED (MO. & YR.)
TO:
FROM:

(

NAME OF SUPERVISOR:
STATE JOB TITLE AND DESCRIBE YOUR WORK:
VERIFIEDD

)

RATE OF PAY
START:

LAST:

REASON FOR LEAVING:

COMMENTS:

COMPANY NAME:

TELEPHONE:

ADDRESS:

EMPLOYED (MO. & YR.)
TO:
FROM:

(

NAME OF SUPERVISOR:
STATE JOB TITLE AND DESCRIBE YOUR WORK:
VERIFIEDD

)

RATE OF PAY
START:

LAST:

REASON FOR LEAVING:

COMMENTS:

COMPANY NAME:

TELEPHONE:

ADDRESS:

EMPLOYED (MO. & YR.)
TO:
FROM:

(

NAME OF SUPERVISOR:
STATE JOB TITLE AND DESCRIBE YOUR WORK:
VERIFIEDD

)

RATE OF PAY
START:

LAST:

REASON FOR LEAVING:

COMMENTS:

CERTIFICATION - PLEASE READ, SIGN AND DATE
All applicants for employment are judged solely on the basis of qualification and ability without regard to age, sex, race, national origin, religion, sexual orientation, marital status, disability, veteran status or other classification protected by law.
I acknowledge that the Company follows an employment - at - will policy, such that I or the Company may terminate my employment at any