Company Name:
Address:
City, State:
Zip: Phone:
Your job:
Supervisor:
Dates Employed:
From To
Last pay rate:
Reason for leaving:
Company Name:
Address:
City, State:
Zip: Phone:
Your job:
Supervisor:
Dates employed:
From To
Last pay rate:
Reason for leaving:
Company Name:
Address:
City, State:
Zip: Phone:
Your job:
Supervisor:
Dates employed:
From To
Last pay rate:
Reason for leaving:
Company Name:
Address:
City, State:
Zip: Phone:
Your job:
Supervisor:
Dates employed:
From To
Last pay rate:
Reason for leaving:
Name: E-mail: Phone:
Name: E-mail: Phone:
Employment History
List your entire employment history, beginning with your current employer. For any unemployed or
self-employed periods, provide dates and locations. (Attach additional sheets if necessary.)
If you are currently employed, may we contact your current employer? Yes No
References
List two people (not relatives) you have worked with who we may contact.
IMPORTANT – We are glad you are interested in joining the Walmart team. Please read the following statements carefully and return this application.
Wal-Mart Stores, Inc., in considering my application for employment, may verify the information set forth on this application and obtain
additional background information relating to my background. I authorize all persons, schools, companies, corporations, credit bureaus and
law enforcement agencies to supply any information concerning my background. I have read, understand and agree to this statement.
(Please initial here.) ______
I understand that Wal-Mart Stores, Inc. has a commitment to maintain an alcohol/drug-free workplace and that Walmart, unless prohibited by state
law, requires a drug screening test as a part of its selection and hiring process. I understand that such drug screening will consist of the testing of
a urine sample or other medically recognized test designed to detect traceable amounts of a controlled substance in my body. If after a second
con rmatory test using the gas chromatography/mass spectrometry method, it is determined my specimen contains a controlled substance or was
adultered or substituted, I will be disquali ed from consideration for employment and any o er of employment will be withdrawn. I further under-
stand and agree that if I am employed, I may be required to submit to alcohol/drug-testing under certain circumstances during my employment. I
have read, understand, and agree to this statement. (Please initial here.) ______
I certify that the information on this application is correct and I understand that any misrepresentation or omission of any information will result in
my disquali cation from consideration for employment or, if employed, my dismissal. I understand that this application is not a contract, o er, or
promise of employment and that if hired, I will be able to resign at any time for any reason. Likewise, the company can terminate my employment at
any time with or without cause, unless otherwise required by law. I further understand that no one other than the President of Wal-Mart Stores, Inc.,
or Vice President of its People Division has the authority to enter into an employment contract or agreement with me, and that my at-will employ-
ment can be changed only by a written agreement signed by the President of Wal-Mart Stores, Inc. I have read, understand and agree to this state-
ment. (Please initial here.) ______
I understand that this application is good only for sixty (60) days from today’s date. If I still desire a position with the company after this application
expires, it will be my responsibility to complete a new application and le it with the company. Otherwise, the company will not consider me for
employment after this application expires.
Date of Application Signature
(as appears on Social Security Card)
Wal-Mart Stores, Inc. will provide a reasonable accommodation during the application
and/or hiring process for individuals with disabilities. Please advise us if you need
assistance with the application and/or hiring process to accommodate a disability.
WMP - 24 Z
[9951356]
Rev. June 2010
Application for Employment
Wal-Mart Stores, Inc.
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