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Costco Job Application Form

To join Costco Wholesale Club as an employee, applicant must accomplish this form and submit it to the manager of the preferred Costco site.Download

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F	O	R	M	 	#	P	R	0	2	U	K	 0	1	/	0	7	    A	P	P	L	I	C	A	T	I	O	N	 	F	O	R	 	E	M	P	L	O	Y	M	E	N	T	 (PL	EA	S	E 	W	R	I	T	E 	C	L	EA	R	L	Y)	  C	A	R	E	E	R	 	O	P	P	O	R	T	U	N	I	T	Y	 	P	R	E	F	E	R	E	N	C	E	 	S	H	E	E	T	   D	a	t	e	 	o	f	 	A	p	p	l	i	ca	t	i	o	n	:	 	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	  N	a	m	e	:	 	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	  S	i	g	n	a	t	u	r	e	:	 	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	_	  C	o	s	t	c	o	 	o	f	f	e	r	s	 	a	 	v	a	r	ie	t	y	 	o	f	 	r	e	w	a	r	d	in	g	 	e	n	t	r	y	-le	v	e	l 	c	a	r	e	e	r	 	o	p	p	o	r	t	u	n	it	ie	s	.	 	P	le	a	s	e	 	p	la	c	e	 	a	n	 	“	X	”	 	in	 	t	h	e	 	“	S	e	le	c	t	”	 	c	o	lu	m	n	 	f	o	r	 	t	h	e	 	p	o	s	it	io	n	(	s	)	 	t	h	a	t	 	b	e	s	t	 	m	a	t	c	h	 	y	o	u	r	 	s	k	ills	 	a	n	d	 	a	b	ilit	ie	s	 	a	n	d	 	f	o	r	 	w	h	ic	h	 	y	o	u	 	w	is	h	 	t	o	 	a	p	p	ly	.	 	  N	o	t	e	 	t	h	a	t	 	C	o	s	t	c	o	 	m	a	y	 	n	o	t	 	h	a	v	e	 	o	p	e	n	 	o	p	p	o	r	t	u	n	it	ie	s	 	f	o	r	 	e	a	c	h	 	d	e	p	a	r	t	m	e	n	t	 	o	r	 	p	o	s	it	io	n	 	y	o	u	 	s	e	le	c	t	.	  Sel	ec	t	 X T	y	p	i	cal	 	E	n	tr	y	-L	ev	el	 	P	o	si	ti	o	n	s 	a	n	d	 	J	o	b	 	S	u	mm	a	r	i	es	 U	s	u	al	 	w	o	r	k 	s	h	i	ft(	s) 	m	ay 	r	an	g	e 	fr	o	m	:	  M	er	c	h	a	n	d	i	se 	S	t	o	c	ker	 – S	to	c	k	s	 a	n	d	 s	t	r	a	ig	h	te	n	s	 m	e	r	c	h	a	n	d	is	e	 	fo	r	 s	a	le	 	in	 v	a	r	io	u	s	 a	r	e	a	s	 in	 th	e	 w	a	r	e	h	o	u	s	e	.	 5	:	0	0	 	a	.	m	.	 	– 	1	0	:	0	0	 	p	.	m	.	  B	ak	er	y 	A	s	si	st	a	n	t 	– M	ix	e	s	, a	s	s	is	ts	 w	ith	 b	a	k	in	g	,	 a	n	d	 w	r	a	p	s	 	b	a	k	e	r	y	 ite	m	s	 fo	r	 s	a	le	.	  C	le	a	n	 u	p	 a	n	d	 in	v	e	n	to	r	y	 d	u	t	ie	s	.	 5	:	0	0	 	a	.	m	.	 	– 	1	0	:	0	0	 	p	.	m	.	  F	o	o	d	 	C	o	u	r	t 	A	s	si	st	a	n	t	– P	r	e	p	a	r	e	s	 a	n	d	 s	e	lls	 fo	o	d	 a	n	d	 d	r	in	k	s	 to	 	c	u	s	to	m	e	r	s	.  P	u	lls	 a	n	d	 s	to	c	k	s	 	s	u	p	p	lie	s	 a	n	d	 in	g	r	e	d	ie	n	ts	,	 c	le	a	n	s	 k	itc	h	e	n	 	a	r	e	a	 a	n	d	 e	a	tin	g	 a	r	e	a	.	  P	r	o	v	id	e	s	 p	r	o	m	p	t	 a	n	d	 c	o	u	r	te	o	u	s	 m	e	m	b	e	r	 	s	e	r	v	ic	e	.	 7	:	0	0	 	a	.	m	.	 	– 	1	0	:	0	0	 	p	.	m	.	  Ser	vi	ce 	D	el	i	 	A	s	si	st	a	n	t	 – P	r	e	p	a	r	e	s	,	 p	a	c	k	a	g	e	s	 a	n	d	 la	b	e	ls	 	m	e	a	ls	, e	n	tr	e	e	s	,	 s	a	la	d	s	, p	a	r	ty	 t	r	a	y	s	, r	o	tis	s	e	r	ie	 c	h	ic	k	e	n	, 	r	ib	s	,	 s	u	s	h	i, a	n	d	 	s	lic	e	d	 m	e	a	ts	 a	n	d	 c	h	e	e	s	e	s	. A	s	s	e	m	b	le	s	 ta	k	e	-a	n	d	-b	a	k	e	 p	iz	z	a	s	.	 7	:	0	0	 	a	.	m	.	 	– 	1	0	:	0	0	 	p	.	m	.	  T	r	o	l	l	ey 	A	ssi	s	ta	n	t	 – R	e	t	r	ie	v	e	s	 t	r	o	lle	y	s	 a	n	d	 f	la	tb	e	d	s	 f	r	o	m	 	p	a	r	k	in	g	 	a	r	e	a	.  K	e	e	p	s	 c	a	r	p	a	r	k	 a	r	e	a	 a	n	d	 f	r	o	n	t o	f b	u	ild	in	g	 f	r	e	e	 o	f d	e	b	r	is	. 	A	s	s	is	ts	 	m	e	m	b	e	r	s	 in	 	lo	a	d	in	g	 m	e	r	c	h	a	n	d	i	s	e	. 	 P	r	o	v	id	e	s	 a	 h	ig	h	 	le	v	e	l o	f	 m	e	m	b	e	r	 	s	e	r	v	ic	e	.	 1	0	:	0	0	 	a	.	m	.	 	– 	1	0	:	0	0	 	p	.	m	.	  F	r	o	n	t 	E	n	d	 	A	ssi	s	ta	n	t	 – P	a	c	k	s	 m	e	m	b	e	r	 o	r	d	e	r	s	 in	to	 b	o	x	e	s	 a	n	d	 	tr	a	n	s	fe	r	s	 	ite	m	s	 	to	 a	 s	e	p	a	r	a	te	 tr	o	lle	y	 fo	r	 C	a	s	h	ie	r	s	. P	e	r	fo	r	m	s	 c	le	a	n	-u	p	, 	tr	o	lle	y	 	r	e	t	r	ie	v	a	l,	 m	e	r	c	h	a	n	d	is	e	 r	e	s	to	c	k	in	g	, a	n	d	 	m	e	m	b	e	r	 a	s	s	is	ta	n	c	e	 a	s	 	d	ir	e	c	te	d	. P	r	o	v	id	e	s	 a	 h	ig	h	 le	v	e	l o	f 	m	e	m	b	e	r	 s	e	r	v	ic	e	.	 8	:	0	0	 	a	.	m	.	 	– 	1	0	:	0	0	 	p	.	m	.	  M	em	b	er	 	S	er	vi	c	e 	A	ssi	sta	n	t	 - A	c	t	iv	e	ly	 g	r	e	e	ts	 	in	c	o	m	in	g	 	m	e	m	b	e	r	s	, v	e	r	ifie	s	 	m	e	m	b	e	r	s	h	ip	 c	a	r	d	.	  K	e	e	p	s	 e	n	t	r	y	 c	o	u	n	ts	.  	P	e	r	fo	r	m	s	 	w	a	r	e	h	o	u	s	e	 s	a	fe	ty	 a	n	d	 s	e	c	u	r	ity	 c	h	e	c	k	s	. C	h	e	c	k	s	 m	e	m	b	e	r	 r	e	c	e	ip	ts	 a	t 	e	x	it a	n	d	 th	a	n	k	s	 m	e	m	b	e	r	.  P	r	o	v	id	e	s	 a	 h	ig	h	 	le	v	e	l o	f	 m	e	m	b	e	r	 s	e	r	v	ic	e	.	 8	:	0	0	 	a	.	m	.	 	– 	1	0	:	0	0	 	p	.	m	.	  M	em	b	er	s	h	i	p	 	A	s	si	st	a	n	t	 – P	r	o	c	e	s	s	e	s	 m	e	m	b	e	r	s	h	ip	 s	ig	n	 	u	p	s	 a	n	d	 	r	e	n	e	w	a	ls	. E	d	u	c	a	te	s	 m	e	m	b	e	r	s	 a	n	d	 p	o	te	n	tia	l 	m	e	m	b	e	r	s	 a	b	o	u	t 	m	e	m	b	e	r	s	h	ip	 a	n	d	 w	a	r	e	h	o	u	s	e	 e	x	p	e	r	ie	n	c	e	. P	r	o	v	id	e	s	 a	 h	ig	h	 le	v	e	l o	f 	m	e	m	b	e	r	 s	e	r	v	ic	e	.	 9	:	0	0	 	a	.	m	.	 	– 	1	0	:	0	0	 	p	.	m	.	  A	n	y 	A	vai	l	a	b	l	e 	O	p	p	o	r	t	u	n	i	ty	 5	:	0	0	 	a	.	m	.	 	– 	1	0	:	0	0	 	p	.	m	.	  C	o	s	t	c	o	 	m	a	y	 	h	a	v	e	 	o	t	h	e	r	 	o	p	p	o	r	t	u	n	it	ie	s	 	a	v	a	ila	b	le	 	f	o	r	 	e	x	p	e	r	ie	n	c	e	d	 	c	a	n	d	id	a	t	e	s	 	w	it	h	 	s	k	ills	 	a	n	d	 	a	b	ilit	ie	s	 	f	r	o	m	 	p	r	io	r	,	 	r	e	la	t	e	d	 	w	o	r	k	.	 	 	E	x	p	e	r	ie	n	c	e	d	 	c	a	n	d	id	a	t	e	s	 	a	r	e	 	e	n	c	o	u	r	a	g	e	d	 	t	o	 	in	d	ic	a	t	e	 	t	h	e	ir	 	in	t	e	r	e	s	t	 	in	 	s	p	e	c	if	ic	 	s	k	ille	d	 	p	o	s	it	io	n	s	 	o	n	 	t	h	e	 	f	o	llo	w	in	g	 	p	a	g	e	s	 	o	f	 	t	h	e	 	C	o	s	t	c	o	 	J	o	b	 	A	p	p	lic	a	t	io	n	 	F	o	r	m	.	  C	o	s	t	c	o	’s	 	s	t	r	o	n	g	 	c	o	r	p	o	r	a	t	e	 	c	u	lt	u	r	e	 	is	 	b	a	s	e	d	 	o	n	 	in	d	iv	id	u	a	l 	r	e	s	p	o	n	s	ib	ilit	y	 	a	n	d	 	in	it	ia	t	iv	e	.	 	 	W	e	 	b	e	lie	v	e	 	s	t	r	o	n	g	ly	 	in	 	t	h	e	 	s	y	n	e	r	g	y	 	o	f	 	id	e	a	s	 	a	n	d	 	a	r	e	 	c	o	m	m	it	t	e	d	 	t	o	 	d	iv	e	r	s	it	y	,	 	e	q	u	a	l 	e	m	p	lo	y	m	e	n	t	 	o	p	p	o	r	t	u	n	it	ie	s	,	 	a	n	d	 	a	 	d	r	u	g	- 	a	n	d	 	a	lc	o	h	o	l	-f	r	e	e	 	w	o	r	k	p	la	c	e	.

F	O	R	M	 	#	P	R	0	2	U	K	 0	1	/	0	7	   A	P	P	L	I	C	A	T	I	O	N	 	F	O	R	 	E	M	P	L	O	Y	M	E	N	T	   E	M	P	L	O	Y	E	E	 	C	O	M	M	I	T	M	E	N	T	   C	O	S	T	C	O	 	W	H	O	L	E	S	A	L	E	 	I	S	 	C	O	M	M	I	T	T	E	D	 	T	O	 	E	X	C	E	L	L	E	N	C	E	 	I	N	 	M	E	M	B	E	R	 	S	E	R	V	I	C	E	.	 	 	O	U	R	 	E	M	P	L	O	Y	E	E	S	 	R	E	F	L	E	C	T	 	T	H	I	S	 	C	O	M	M	I	T	M	E	N	T	.	  • W	e	 	b	e	l	i	e	ve	 	t	h	a	t	 	C	o	st	co	 	W	h	o	l	e	sa	le	 	p	r	o	vi	d	e	s 	a	 	g	r	e	a	t	 	sh	o	p	p	i	n	g	 	e	xp	e	r	i	e	n	ce	 	a	n	d	 	i	s 	f	u	n	 	f	o	r	 	o	u	r	 	m	e	m	b	e	r	s 	a	n	d	 	o	u	r	 	e	m	p	l	o	ye	e	s	.	 	 	  • W	e	 	b	e	l	i	e	ve	 	t	h	a	t	 	i	f	 	yo	u	 	d	o	n	't	 	w	a	n	t	 	t	o	 	d	o	 	yo	u	r	 	b	e	st	,	 	C	o	st	co	 	W	h	o	l	e	s	a	l	e	 	i	s 	n	o	t	 	t	h	e	 	p	l	a	ce	 	f	o	r	 	y	o	u	.	 	  • W	e	 	b	e	l	i	e	ve	 	i	n	 	h	i	r	i	n	g	 	i	n	d	i	vi	d	u	a	l	s 	w	i	t	h	 	a	 	h	i	g	h	 	e	n	e	r	g	y 	l	e	ve	l	 	a	n	d	 	a	 	p	o	si	t	i	ve	 	a	t	t	i	t	u	d	e	.	 	  • W	e	 	b	e	l	i	e	ve	 	t	h	a	t	 	o	u	r	 	e	m	p	l	o	ye	e	s 	a	r	e	 	t	h	e	 	b	e	st	 	i	n	 	t	h	e	 	w	h	o	l	e	sa	l	e	 	i	n	d	u	st	r	y	.	 	  • W	e	 	b	e	l	i	e	ve	 	i	n	 	r	e	co	g	n	i	si	n	g	 	a	n	d	 	r	e	w	a	r	d	i	n	g	 	p	o	si	t	i	ve	 	b	e	h	a	vi	o	u	r	 	a	n	d	 	p	e	r	f	o	r	m	a	n	ce	.	 	  • W	e	 	i	n	si	st	 	o	n	 	co	u	r	t	e	o	u	s,	 	f	r	i	e	n	d	l	y 	a	n	d	 	r	e	sp	o	n	si	b	l	e	 	b	e	h	a	vi	o	u	r	 	a	n	d	 	p	e	r	f	o	r	m	a	n	ce	.	 	  • W	e	 	b	e	l	i	e	ve	 	"	g	o	o	d	 	e	n	o	u	g	h	"	 	i	s	n	't	.	 	  • W	e	 	b	e	l	i	e	ve	 	i	n	 	h	e	l	p	in	g	 	yo	u	 	a	ch	i	e	ve	 	yo	u	r	 	p	e	r	so	n	a	l	 	a	n	d	 	p	r	o	f	e	ssi	o	n	a	l	 	g	o	a	l	s 	a	n	d	 	a	r	e	 	co	m	m	i	t	t	e	d	 	t	o	 	p	r	o	m	o	t	i	n	g	 	o	u	r	 	su	p	e	r	vi	so	r	y 	a	n	d	 	m	a	n	a	g	e	m	e	n	t	 	p	o	si	t	i	o	n	s 	p	r	i	m	a	r	i	l	y 	f	r	o	m	 	w	i	t	h	i	n	 	t	h	e	 	co	m	p	a	n	y.	 	 	  • W	e	 	t	a	ke	 	p	r	i	d	e	 	i	n	 	t	h	e	 	a	p	p	e	a	r	a	n	ce	 	o	f	 	o	u	r	 	e	m	p	l	o	ye	e	s 	a	n	d	 	h	a	ve	 	e	st	a	b	l	i	sh	e	d	 	g	r	o	o	m	i	n	g	 	st	a	n	d	a	r	d	s 	a	n	d	 	d	r	e	ss 	co	d	e	s	 	t	o	 	e	n	s	u	r	e	 	t	h	e	 	m	a	i	n	t	e	n	a	n	c	e	 	o	f	 	a	 	p	r	o	f	e	ssi	o	n	a	l	 	im	a	g	e	.	  • W	e	 	p	r	i	d	e	 	o	u	r	se	l	ve	s 	o	n	 	o	u	r	 	sa	f	e	 	w	o	r	ki	n	g	 	e	n	vi	r	o	n	m	e	n	t	 	a	n	d	 	h	a	v	e	 	sa	f	e	t	y 	p	o	l	i	ci	e	s,	 	w	h	i	ch	 	i	n	cl	u	d	e	 	su	b	st	a	n	ce	 	a	b	u	se	 	t	e	s	t	i	n	g	 	(	w	h	e	n	 	a	p	p	r	o	p	r	i	a	t	e	)	 	t	h	a	t	 	p	r	o	t	e	ct	 	e	ve	r	y 	e	m	p	lo	ye	e	.	 	  • W	e	 	d	o	 	p	e	r	f	o	r	m	 	p	r	e	vi	o	u	s	 	e	m	p	l	o	y	e	r	 	r	e	f	e	r	e	n	ce	 	c	h	e	cks.	  • W	e	 	o	f	f	e	r	 	t	h	e	 	b	e	st	 	c	o	m	p	e	n	sa	t	i	o	n	 	a	n	d	 	b	e	n	e	f	i	t	s 	p	a	cka	g	e	 	i	n	 	t	h	e	 	i	n	d	u	s	t	r	y.	  • W	e	 	w	a	n	t	 	yo	u	 	t	o	 	w	o	r	k 	h	a	r	d	 	a	n	d	 	h	a	ve	 	f	u	n	!	    I	f	 	t	h	i	s	 	so	u	n	d	s 	l	i	ke	 	t	h	e	 	e	n	vi	r	o	n	m	e	n	t	 	f	o	r	 	y	o	u	,	 	p	l	e	a	se	 	f	i	l	l	 	o	u	t	 	t	h	e	 	a	p	p	l	i	ca	t	i	o	n	 	f	o	r	m	 	o	n	 	t	h	e	 	f	o	l	l	o	w	i	n	g	 	p	a	g	e	s!

F	O	R	M	 	#	P	R	0	2	U	K	 0	1	/	0	7	  A	P	P	L	I	C	A	T	I	O	N	 	F	O	R	 	E	M	P	L	O	Y	M	E	N	T	   P	L	E	A	S	E	 	W	R	I	T	E	 	C	L	E	A	R	L	Y	    C	o	s	t	c	o	 	p	r	o	v	id	e	s	 	e	q	u	a	l 	o	p	p	o	r	t	u	n	it	y	 	in	 	a	ll 	a	r	e	a	s	 	o	f	 	e	m	p	lo	y	m	e	n	t	 	a	n	d	 	d	o	e	s	 	n	o	t	 	d	is	c	r	im	in	a	t	e	 	a	g	a	in	s	t	 	a	n	y	 	in	d	iv	id	u	a	l 	o	n	 	t	h	e	 	b	a	s	is	 	o	f	 	r	a	c	e	,	 	c	o	lo	r	,	 	s	e	x	,	 	m	a	r	it	a	l 	s	t	a	t	u	s	,	 	r	e	lig	io	n	,	 	a	g	e	 	(	if	 	a	t	 	le	a	s	t	 	1	8	)	,	 	n	a	t	io	n	a	l 	o	r	ig	in	,	 	o	r	 	d	is	a	b	ilit	y	.	     F	IR	S	T	 N	A	M	E	  L	A	S	T	 N	A	M	E	  IN	IT	IA	L	  N	.I.	 N	U	M	B	E	R	   A	D	D	R	E	S	S	    P	O	S	T	C	O	D	E	  H	O	M	E	 T	E	L	.	 N	O	.	  W	O	R	K	 T	E	L	.	 N	O	.	  A	R	E	 Y	O	U	 L	E	G	A	L	L	Y	 A	B	L	E	 T	O	 	W	O	R	K	 	IN	 T	H	IS	 C	O	U	N	T	R	Y	?	  	 Y	E	S	 	 	 N	O	 P	O	S	IT	IO	N	 O	R	 T	Y	P	E	 O	F	 E	M	P	L	O	Y	M	E	N	T	 D	E	S	IR	E	D	     	  	   	  	   	 A	V	A	IL	A	B	L	E	 F	O	R	 	  F	U	L	L	 T	I	M	E	  	  	   	 	 P	A	R	T	 T	I	M	E	 	 D	A	T	E	 A	V	A	IL	A	B	L	E	 F	R	O	M	  H	O	U	R	S	 A	V	A	IL	A	B	L	E	  H	A	V	E	 Y	O	U	 E	V	E	R	 B	E	E	N	 E	M	P	L	O	Y	E	D	 B	Y	 	O	R	 A	P	P	L	IE	D	 F	O	R	 E	M	P	L	O	Y	M	E	N	T	 	W	IT	H	 T	H	IS	 C	O	M	P	A	N	Y	?	 	  	  	 Y	E	S	 	 	 	N	O	 IF	 Y	E	S	,	 P	L	E	A	S	E	 IN	D	IC	A	T	E	 T	H	E	 C	O	S	T	C	O	 L	O	C	A	T	IO	N	 W	H	E	R	E	 Y	O	U	 	W	E	R	E	 E	M	P	L	O	Y	E	D	 A	N	D	 	D	A	T	E	S	 O	F	 E	M	P	L	O	Y	M	E	N	T	 	 O	R	 D	A	T	E	 O	F	 P	R	E	V	IO	U	S	 A	P	P	L	IC	A	T	I	O	N	 L	O	C	A	T	IO	N	  D	A	T	E	S	  H	A	V	E	 Y	O	U	 A	N	Y	 C	O	N	V	I	C	T	IO	N	S	 F	O	R	 A	 	C	R	IM	IN	A	L	 O	F	F	E	N	C	E	 (	O	T	H	E	R	 T	H	A	N	 M	O	T	O	R	IN	G	 O	F	F	E	N	C	E	S	)	 	 Y	E	S	   N	O	 IF	 Y	E	S	,	 P	L	E	A	S	E	 G	IV	E	 D	E	T	A	IL	S	  P	E	R	S	O	N	A	L	             L	IS	T	 S	C	H	O	O	L	 	O	R	 C	O	L	L	E	G	E	 M	O	S	T	 R	E	C	E	N	T	L	Y	 A	T	T	E	N	D	E	D	 A	N	D	 E	X	A	M	IN	A	T	IO	N	S	 P	A	S	S	E	D	.	 	 G	IV	E	 D	E	T	A	IL	S	 O	F	 A	N	Y	 A	P	P	R	E	N	T	IC	E	S	H	IP	 O	R	 O	T	H	E	R	 T	R	A	IN	IN	G	 S	C	H	E	M	E	.	  S	C	H	O	O	L	/C	O	L	L	E	G	E	/E	M	P	L	O	Y	E	R	 E	X	A	M	IN	A	T	IO	N	S	/	 Q	U	A	L	IF	IC	A	T	IO	N	S	 D	A	T	E           E	D	U	C	A	T	I	O	N	    W	H	AT	 M	AC	H	IN	ES	 O	R	 EQ	U	IPM	EN	T	 C	AN	 YO	U	 	O	PER	AT	E	?	    F	O	R	KL	IF	T	    PAL	L	ET	 T	R	U	C	K	 	    EL	EC	. PA	L	L	ET	 T	R	U	C	K	   F	L	O	O	R	 SC	R	U	BBE	R	   BAKER	Y 	EQ	U	IP	   C	ASH	 R	EG	IST	E	R	   AS4	0	0	 / I	-SER	IES	   PC	 	– W	O	R	D	   PC	 	– EXC	E	L	  M	E	AT	 D	E	PT	 EQ	U	IP	   F	O	O	D	 PR	E	P 	EQ	U	IP	   T	YR	E 	SH	O	P 	EQ	U	IP 	   O	PT	IC	A	L	 EQ	U	IP	   1	 H	R	 PH	O	T	O	 EQ	U	IP	   VAU	L	T	 / C	ASH	 O	F	F	IC	E 	EQ	U	IP	 O	T	H	ER	  S	K	I	L	L	S	/	T	R	A	I	N	I	N	G

F	O	R	M	 	#	P	R	0	2	U	K	 0	1	/	0	7	         PLEASE LIST YO	UR LAST 3 E	MPLOYE	RS	  PR	ESEN	T	 O	R	 L	AST	 E	M	PL	O	Y	ER	 N	EXT	 T	O	 L	A	ST	 EM	PL	O	YE	R	 SEC	O	N	D	 F	R	O	M	 L	AS	T	 E	M	P	L	O	YER	  C	O	M	PAN	Y 	N	A	M	E	     AD	D	R	ESS	        PH	O	N	E 	N	U	M	BER	 W	/ AR	EA 	C	O	D	E	     J	O	B 	T	IT	L	E/	K	IN	D	 O	F	 	W	O	R	K	     D	AT	E 	S	T	AR	T	ED	     D	AT	E 	L	EF	T	     W	AG	E 	– ST	AR	T	 / L	AST	        N	AM	E	 O	F	 SU	PER	VI	SO	R	     R	EASO	N	 F	O	R	 L	E	AVI	N	G	     R	EF	ER	EN	C	E 	N	A	M	E	     R	EF	ER	EN	C	E 	PH	O	N	E	 #	    E	M	P	L	O	Y	M	E	N	T	 P	le	a	s	e	 u	s	e	 a	d	d	itio	n	a	l s	h	e	e	ts	 if n	e	c	e	s	s	a	r	y	.  Y	o	u	 m	a	y	 a	ls	o	 b	e	 	a	s	k	e	d	 to	 p	r	o	v	id	e	 a	d	d	itio	n	a	l w	o	r	k	 h	is	to	r	y	.	            P	L	E	A	SE 	R	E	A	D	 	C	A	R	E	F	U	L	L	Y	 C	a	re	f	u	lly	 	re	a	d	 	t	h	e	 	f	o	llo	w	in	g	 	s	t	a	t	e	m	e	n	t	s	 	a	n	d	 	a	g	re	e	m	e	n	t	 	b	e	f	o	re	 	s	ig	n	in	g	 	t	h	e	 	a	p	p	lic	a	t	io	n	. 1	.	 I	 	c	e	rt	if	y	 	t	h	a	t	 	t	h	e	 	in	f	o	rm	a	t	io	n	 	c	o	n	t	a	in	e	d	 	in	 	t	h	is	 	a	p	p	lic	a	t	io	n	 is	 	c	o	rre	c	t	 	t	o	 	t	h	e	 	b	e	s	t	 	o	f	 	m	y	 	k	n	o	w	le	d	g	e	 	a	n	d	 	t	h	a	t	 	a	n	y	 	m	a	t	e	ri	a	l 	m	is	re	p	re	s	e	n	t	a	t	io	n	(s	) 	is	 	g	ro	u	n	d	s	 	f	o	r 	d	is	m	is	s	a	l 	f	ro	m	 	t	h	e	 	e	m	p	lo	y	m	e	n	t	 	o	f	 	C	o	s	t	c	o	 	W	h	o	le	s	a	le	 	U	K 	L	im	it	e	d	 	o	r 	re	je	c	t	io	n	 	o	f	 	m	y	 	a	p	p	lic	a	t	io	n	 	f	o	r 	e	m	p	lo	y	m	e	n	t	.	  2	.	 I	 	a	u	t	h	o	ri	s	e	 	m	y	 	f	o	r	m	e	r 	e	m	p	lo	y	e	rs	 	a	n	d	 	a	n	y	 	o	t	h	e	r 	p	e	rs	o	n	s	 	o	r	 	o	rg	a	n	is	a	t	io	n	s	 	t	o	 	p	ro	v	id	e	 	a	n	y	 	a	c	c	u	ra	t	e	 	a	n	d	 	c	u	rre	n	t	 	in	f	o	rm	a	t	io	n	 	t	h	e	y	 	h	a	v	e	 	a	b	o	u	t	 	m	y	 	b	a	c	k	g	ro	u	n	d	 	a	n	d	 	I	 	re	le	a	s	e	 	a	ll 	c	o	n	c	e	rn	e	d	 	f	ro	m	 	a	n	y	 	lia	b	ilit	y	 	in	 	c	o	n	n	e	c	tio	n	 	t	h	e	re	w	it	h	.	 	  3	.	 I	 	u	n	d	e	r	s	t	a	n	d	 	t	h	a	t	 	t	h	e	 	f	ir	s	t	 	n	in	e	t	y	 	(	9	0	)	 	d	a	y	s	 	o	f	 	e	m	p	lo	y	m	e	n	t	 	w	ill 	b	e	 	c	o	n	s	id	e	r	e	d	 	a	 	p	r	o	b	a	t	io	n	a	r	y	 	p	e	r	io	d	.	       P	L	E	A	S	E	 	R	E	A	D	 	C	A	R	E	F	U	L	L	Y	  SI	G	N	AT	U	R	E	 O	F	 A	PPL	IC	AN	T	  D	AT	E 	O	F	 SI	G	N	IN	G
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