No applicant shall be required to furnish any information of his or her first arrest for any misdemeanor or felony which did not result in a conviction, unless court action is pending. Nor shall such applicant be required to furnish information on any complaint which was dismissed for want of prosecution or which resulted in the case being continued without a finding for a certain period of time and then dismissed or which resulted in a finding or verdict of not guilty. Nor shall such applicant be require to furnish any information of arrests for the following misdemeanors, drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace; provided that the date of disposition of said offenses was five years or more prior to the filing of said application and that no applicant shall be required to furnish any information concerning any conviction of a misdemeanor which occurred more than five years prior to the date of such application for employment unless the applicant was sentenced to imprisonment upon conviction of such misdemeanor or such individual has been convicted of an offense within five years of such date.

The information given on the application is true and correct to the best of my knowledge. I authorize Circle B Home Center to investigate all statements on this application. Falsification or elimination of information on this application is cause for dismissal at any time if employed. I understand that my application for employment will be processed as quickly as possible and that Public Law 91-508 requires Circle B to inform me that a routine inquiry may be made which will provide applicable information concerning character, general reputation personal characteristics and mode of living. I also understand that any employee of Circle B is free to resign at any time and is subject to termination at any time (with or without notice) and that the employment relationship is not subject to the provisions of any external documents except as expressly provided by management in writing.
I hereby authorize and request any education institution to furnish bearer with any and all information in their possession regarding me in connection with an application for employment. I am will that a photocopy of authorization be accepted with the same authority as the original. I understand that employment by Circle B makes me subject to all provisions of employment-at-will laws. I also understand that any job offers could be contingent on my passing a drug-screening test.

Our retail operation has several different types of positions. Each type has essential job functions listed below. Please respond to the questions listed under the type(s) of job(s) for which you are applying. You may apply for and be interviewed for more than one type of job.

Please add any comments or additional information you feel is applicable.

By submitting this application, you are stating that you understand the Circle B Home Center is legally permitted to require a physical examination, as a condition of employment, once a job offer has been made. You certify that your responses above are true and correct and that you know of no limitations which would prevent you from performing the essential job functions.