THREE BEARS ALASKA - EMPLOYMENT APPLICATION

As an equal opportunity employer, Three Bears Alaska, Inc. does not discriminate in hiring or in terms and conditions of employment because of an individual's race, creed, color, sex, age, religion, disability, national origin, or other statuses protected by federal, state, or local law.

Position(s) Applied For*

Date of Application*

Date

If Applying for Liquor store position, are you 21 or older?

Do you have a current TAM Card?

Name*

First NameMiddle NameLast Name

Address*

CITY*

STATE*

ZIP CODE*

Previous Address

Street Address Line 2

CITYSTATE

ZIP CODE

Telephone*

Other Phone

If you are under 18 can you furnish a work permit?

YesNo

If no, please explain:

Are you legally eligible for employment in this country?*

YesNo

Have you been employed with Three Bears before?*

YesNo

If Yes, when?

Type of work desired*

Full TimePart TimeTemporarySeasonal

Date available for work*

Date

Mon.*

Tues.*

Wed.*

Thu.*

Fri.*

Sat.*

Sun.*

EMPLOYER

EMPLOYER'S TELEPHONE NUMBER

EMPLOYER'S ADDRESS

SUPERVISOR'S NAME

SUPERVISOR'S TITLE

EMPLOYED FROM

Date

EMPLOYED UNTIL

Date

JOB TITLE

NATURE OF WORK AND RESPONSIBILITIES

STARTING PAY

PER (hour, day, week, etc.)

FINAL PAY

PER (hour, day, week, etc.)

REASON FOR LEAVING

EMPLOYER

EMPLOYER'S TELEPHONE NUMBER

EMPLOYER'S ADDRESS

SUPERVISOR'S NAME

SUPERVISOR'S TITLE

EMPLOYED FROM

Date

EMPLOYED UNTIL

Date

JOB TITLE

NATURE OF WORK AND RESPONSIBILITIES

STARTING PAY

PER (hour, day, week, etc.)

FINAL PAY

PER (hour, day, week, etc.)

REASON FOR LEAVING

EMPLOYER

EMPLOYER'S TELEPHONE NUMBER

EMPLOYER'S ADDRESS

SUPERVISOR'S NAME

SUPERVISOR'S TITLE

EMPLOYED FROM

Date

EMPLOYED UNTIL

Date

JOB TITLE

NATURE OF WORK AND RESPONSIBILITIES

STARTING PAY

PER (hour, day, week, etc.)

FINAL PAY

PER (hour, day, week, etc.)

REASON FOR LEAVING

EMPLOYER

EMPLOYER'S TELEPHONE NUMBER

EMPLOYER'S ADDRESS

SUPERVISOR'S NAME

SUPERVISOR'S TITLE

EMPLOYED FROM

Date

EMPLOYED UNTIL

Date

JOB TITLE

NATURE OF WORK AND RESPONSIBILITIES

STARTING PAY

PER (hour, day, week, etc.)

FINAL PAY

PER (hour, day, week, etc.)

REASON FOR LEAVING

High School*

Years Completed*

Did you Graduate?*

Course of Study

College

Years Completed

Major

Degree

Course of Study

Other

Years Completed

Did you Graduate?

Course of Study

0/25

Have you been convicted (by entry of a plea or otherwise) of a felony or misdemeanor crime in the last seven (7) years? (Responding yes is not an automatic bar to employment)*

If yes, please explain

Driver's license number if driving is an essential job function

State

Name

Years Known

Relationship

Telephone Number

Please enter a valid phone number.

Name

Years Known

Relationship

Telephone Number

Please enter a valid phone number.

Name

Years Known

Relationship

Telephone Number

Please enter a valid phone number.

I HEREBY ATTEST THAT THE FACTS SET FORTH IN MY APPLICATION FOR EMPLOYMENT WITH THREE BEARS ALASKA, INC. (THE "COMPANY") ARE TRUE AND COMPLETE. I UNDERSTAND THAT IF EMPLOYED, FALSE OR INCOMPLETE STATEMENTS ON THIS APPLICATION MAY RESULT IN MY IMMEDIATE DISMISSAL. I HEREBY AUTHORIZE THE COMPANY TO CONTACT AND OBTAIN INFORMATION FROM ALL REFERENCES, EMPLOYERS, EDUCATIONAL INSTITUTIONS AND OTHERWISE VERIFY THE ACCURACY OF THE INFORMATION CONTAINED IN THIS APPLICATION. I HEREBY RELEASE FROM LIABILITY THE COMPANY AND ITS REPRESENTATIVES FOR SEEKING, GATHERING AND USING SUCH

INFORMATION. I HEREBY AUTHORIZE MY FORMER EMPLOYERS AND ANY OTHER PERSONS OR ORGANIZATIONS TO PROVIDE ANY

INFORMATION THAT MAY BE REQUESTED, AND I RELEASE FROM LIABILITY ALL PERSONS AND ORGANIZATIONS SUPPLYING SUCH

THIS APPLICATION DOES NOT CONSTITUTE AN AGREEMENT OR CONTRACT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OR DEFINITE DURATION.I UNDERSTAND THAT NO REPRESENTATIVE OF THE COMPANY, OTHER THAN AN AUTHORIZED OFFICER, HAS THE AUTHORITY TO MAKE ANY ASSURANCES TO THE CONTRARY. I FURTHER UNDERSTAND THAT ANY SUCH ASSURANCES MUST BE IN WRITING AND SIGNED BY AN AUTHORIZED OFFICER.

I UNDERSTAND THAT IT IS THE COMPANY'S POLICY TO HIRE ONLY U.S. CITIZENS AND ALIENS WHO ARE AUTHORIZED TO WORK IN THIS

COUNTRY. AS A CONDITION TO EMPLOYMENT, I WILL BE REQUIRED TO PRODUCE ORIGINAL DOCUMENTS ESTABLISHING MY IDENTITY AND

AUTHORIZATION TO WORK IN THE U.S.

IF EMPLOYMENT IS OFFERED IN A SAFETY-SENSITIVE JOB POSITION, I UNDERSTAND THAT I WILL BE REQUIRED TO SUBMIT TO A DRUG SCREENING TEST. I UNDERSTAND THAT I MUST COMPLY WITH THE COMPANY'S DRUG AND ALCOHOL POLICY.

I UNDERSTAND THAT THIS APPLICATION WILL ONLY BE HELD FOR 30 DAYS. IF I HAVE NOT BEEN CONTACTED BY THE COMPANY DURING

SUCH TIME, I MUST FILL OUT A NEW APPLICATION IF I WISH TO BE CONSIDERED FOR EMPLOYMENT.

I REPRESENT AND WARRANT THAT I HAVE READ AND FULLY UNDERSTAND THE FOREGOING AND SEEK EMPLOYMENT UNDER THESE CONDITIONS.

Signature of Applicant*

Date*

Date

THREE BEARS ALASKA - EMPLOYMENT APPLICATION

Days/Hours available for work (Please fill in times for each day)

Employment History

Educational Background

Additional Skills/Qualifications

References

READ CAREFULLY BEFORE SIGNING