
Employment Application
Thank you for applying to 99 Cents Only Stores, LLC!
99 Cents Only Stores, LLC is firmly committed to ensuring a safe, healthy and efficient work environment for our employees, customers and the public. The company has a
pre-employment drug testing policy, and also reserves the right to require a drug test at any time during employment for reasonable suspicion. Any employee who violates
the drug-free workplace policy will be subject to disciplinary action up to and including termination of employment.
PERSONAL INFORMATION
(please print)
Kindly fill out the application completely and give it to the receptionist or the
store manager. Incomplete applications cannot be accepted.
__________________ _______________ _________ _____ -____-______ (_____) ___________ ________
Last Name First Name Middle Name Social Security Number Phone Number Date
If under 18 years of age, can you provide proof of your ability to work? Yes No NA Are you legally eligible for employment in the US? Yes No
Have you ever been convicted of a crime other than a minor traffic violation (Please note that in answering this question, 99 Cents Only Stores, LLC does
not request, and you should not provide, any information concerning any arrest or detention that did not result in a conviction, any referral to
or participation in any diversion programs, or any conviction from two years ago or earlier for a marijuana-related offense that did not
involve the selling of marijuana.)? Yes No If Yes, please below.
Explain_____________________________________________________________________________________________
(A conviction is not an automatic bar to employment. Each case will be considered on its own merit)
_______________________________________ _____________ ________________ __________ _________ _____________
Present Address Apt/Unit # City State Zip Code County
_______________________________________ _____________ ________________ __________ _________ _____________
Previous Address Apt/Unit # City State Zip Code County
Emergency Contact Information: Name _______________________________ Relationship ___________________ Phone #
(____) _____ ______
EMPLOYMENT DESIRED
(If applying for a retail hourly position, please note that availability of hours may vary and are thus not guaranteed)
Do you have friends/relatives working at 99 Cents Only Stores, LLC? Yes If so, who/where? _______________________ No
Position_________________________ Expected Wage $______per hour Date Available_____________ Have you ever worked for 99 Cents Only Stores, LLC? Yes No
Applying for: Full-time Part-time Temporary If so, when______________ where___________________
Sunday
Monday
Tuesday
Wednesday
Thursday Friday Saturday
Is there any reason why you would not be able to perform all of the job duties of the position you have applied for? Yes No
If Yes, please explain______________________________________________________________________________________________________________________________
EDUCATION
Circle Last Did You Subject(s)
Name and Address of School Year Completed Graduate? Studied
High School
1 2 3 4 Y N
College
Post College
Trade/Business School
Have you ever shopped at 99 Cents Only Stores, LLC? Where? Kindly describe your experience.
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
Why do you want to work for 99 Cents Only Stores, LLC?
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
Describe a specific situation where you provided excellent customer service. Why was it effective?
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
Referred by:
___Person ___________
___Newspaper________
___Walk-in___________
___Other_____________