Applicant Information

Applicant Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Employment Position

Position applying for:(Required)

How did you hear about this position?(Required)

What days are you available for work?(Required)

What hours or shift are you available for work?(Required)

If needed, are you available to work overtime?(Required)

On what date can you start working if you are hired?(Required)

Do you have reliable transportation to and from work?(Required)

Salary desired:(Required)

Personal Information

Are you 18 years of age or older?(Required)

Yes

Are you a U.S. citizen or approved to work in the United States?(Required)

Yes

What document can you provide as proof of citizenship or legal status?(Required)

Will you consent to a mandatory controlled substance test?(Required)

Yes

Do you have any condition which would require job accommodations?(Required)

Yes

If yes, please describe accommodations required below.(Required)

Have you ever been convicted of a criminal offense (felony or misdemeanor)?(Required)

Yes

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:(Required)

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying:(Required)

(Note: Gallery 77 LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. )

Education and Training

High School

Name

Location (City, State)

Year Graduated

Degree Earned

College/University

Name

Location (City, State)

Year Graduated

Degree Earned

Vocational School/Specialized Training

Name

Location (City, State)

Year Graduated

Degree Earned

Are you a member of the Armed Services?(Required)

Yes

What branch of the military did you enlist?(Required)

What was your military rank when discharged?(Required)

How many years did you serve in the military?(Required)

What military skills do you possess that would be an asset for this position?(Required)

Previous Employment

Employer #1

Employer Name

Job Title

Supervisor Name

First Last

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Phone

Dates Employed

Reason for Leaving

Employer #2

Employer Name

Job Title

Supervisor Name

First Last

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Phone

Dates Employed

Reason for Leaving

Employer #3

Employer Name

Job Title

Supervisor Name

First Last

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Phone

Dates Employed

Reason for Leaving

References

References(Required)

Please provide 3 personal and professional reference(s) below:

Name

Contact Information

Additional Information

Do you have a valid drivers license?(Required)

Are you able to lift 75+ pounds with assistance?(Required)

Do you have any issues standing for long periods of time?(Required)

Do you have any hand tool experience?(Required)

At-Will Employment

The relationship between you and the Gallery 77 LLC is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Gallery 77 LLC. No representative of Gallery 77 LLC has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice- President/Chief Operations Officer or the Company's President.

Applicant Name(Required)

Date(Required)

Job Application

Applicant Information

Employment Position

Personal Information

Job Skills/Qualifications

Education and Training

Previous Employment

Employer #1

Employer #2

Employer #3

References

Additional Information

At-Will Employment