Section One:   Personal Information
 First Name:  
Last Name:   
 Street Address:  
City,State,Zip:  
Area Code/Phone:  
Email Address:  
When are you able to start work?  
What is the best time to reach you? (Between 10am & 7pm)  
Who referred you to us?  
If referred to us by a current Driveline Merchandiser, please provide their Payroll ID #
Are you over 18 years of age?   Yes
  No
Are you a US citizen or can you provide evidence of your legal right to work in the US?   Yes
  No
Have you been employed by Driveline Retail Merchandising previously?   Yes
  No
Have you been employed by a merchandising company or retailer?   Yes
  No
If Yes, list:  
Have you ever been convicted of a felony or misdemeanor other than a traffic violation?*


*This question may be modified by certain state-specific restrictions. Please review the rider for your state for the applicable restrictions and answer the question above.		   Yes
  No
If you answered yes, please provide details:  
Section Two:  Retailer Experience
(Check all retailers you are now working in or have worked in):
  K-Mart   Home Improvement/DIY
  Wal-Mart   Warehouse/Club Stores
  Target   Convenience Stores
  Toy Stores   Department Stores
  Drug Stores   Office Supply
  Grocery/Supermarket   Specialty Stores
Section Three:  Skills - Have you in the past:
(check all that apply):
  Stocked/Straightened Shelves   Placed Orders
  Read/Understood Planograms   Reset Section to Planogram
  Cut in New Items to Planogram   Labelled Section to Planogram
  Performed Audits and Inventory   Pulled Items for Return
  Assembled and Install Fixtures   Organized and Scheduled a Reset
  Installed or Replaced Signs   Installed or Replaced POP
Section Four:  Additional - Job Description Specific:
Are You Able to Lift up to 30 lbs?
   Yes
  No
Are You Willing to Lift Up To 30 lbs?   Yes
  No
Are you able to stand, bend and stoop for long periods of time?   Yes
  No
Do you have access to reliable transportation?   Yes
  No
How many hours are you available per week?   0-10 hrs 11-20 hrs 20+ hrs
What days are you available to work?
(check all that apply):		   Mon Tues Wed Thurs Fri Sat Sun
Will you commit to servicing your assigned stores on a specific day of the week?   Yes
  No
Do you have access to a computer, printer, and the Internet?   Yes
  No
Are you able and willing to perform each of the position responsibilities listed on the job description?   Yes
  No
Are you able and willing to meet each of the required skills expectations?   Yes
  No
Can You Work:
Days Nights OverNights Weekends
Yes No Yes No Yes No Yes No
Section Five:   Education History

High School:
College:
Name and Location Degree
Yes No
Yes No
Section Six:   Employment History
Employer #1:
Address:
Position/Title:
Supervisor's Title & Name:
Phone Number:
Employment Dates:  From:   To: 
Final Pay Rate:
Description of Work Duties:
Reason for Leaving:

Employer #2:
Address:
Position/Title:
Supervisor's Title & Name:
Phone Number:
Employment Dates:  From:   To: 
Final Pay Rate:
Description of Work Duties:
Reason for Leaving:
Section Seven:  References
Name:
Phone:
City/State:
Years Known:
Business Relationship:
Name:
Phone:
City/State:
Years Known:
Business Relationship:
Name:
Phone:
City/State:
Years Known:
Business Relationship:
Section Eight:  Optional
Briefly add any additional experience or qualifications Please do not attach or copy/paste your resume:  
Please verify the information you have filled out and acknowledge that you have read the Rider to Employment Application by checking this box:
(required)
RIDER TO EMPLOYMENT APPLICATION

The information provided in the Application for Employment is true, correct and complete. If offered employment of employed by Driveline Retail Merchandising, any misstatement of omission of fact on this application may result in the rescission of the offer of employment or, if already employed, in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon Driveline Retail Merchandising to continue to employ me in the future. In accordance with Federal and Local Law, I authorize Driveline Retail Merchandising to engage an investigative consumer reporting agency to report on my credit and personal history. If such a report is obtained by Driveline Retail Merchandising, Driveline Retail Merchandising will provide, at my request, the name and address of the agency so I may obtain from them the nature and substance of the information contained in the report.

CONVICTION OF A CRIME WILL NOT NECESSARILY DISQUALIFY YOU FROM EMPLOYMENT. IN EACH CASE A DECISION WILL BE MADE BASED ON SUCH FACTORS AS THE NATURE OF THE CRIME AND THE JOB FOR WHICH YOU HAVE APPLIED.

Data Confidentiality

Driveline Retail Merchandising considers this information and its submission as confidential. Driveline Retail Merchandising does not make any of this information public, nor is it sold, shared, or distributed to anyone outside of the Driveline Retail Merchandising organization.


Code of Business Conduct
Driveline Retail Merchandising abides by a Code of Business Conduct. This Code outlines the ethical standards we follow as a company to maintain the confidence of our business partners, other employees, suppliers, shareholders and the general public. We are expected to perform our jobs honestly and in the Company's best interests by following these basic guidelines.
  1. Act in ways that meet or exceed applicable laws and best practice standards where ever Driveline Retail Merchandising does business.
  2. Do not put yourself or Driveline Retail Merchandising, in a conflict of interest
  3. Conduct yourself honestly, professionally and with integrity
  4. Keep communications and information accurate, confidential and secure
  5. Treat everyone fairly and equitably
  6. Report any suspicions of problems, ethical concerns or irregularities to management