PBW Employee Application Please enable JavaScript in your browser to complete this form. - Step 1 of 8Please provide your contact informationName *FirstLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail *NextPlease Tell us more about yourselfAre you over 18?YesNoCan you provide proof of eligibility to work in the US?YesNoLast 4 digits of your SSN #Positions DesiredFull timePart timeTemporaryAvailable Start DateWage/Salary ExpectedMay we contact your present employer?YesNoContact Person Name *Phone NumberPreviousNextPlease show us your available hoursMonday TuesdayWednesdayThursdayFridaySaturdayPreviousNextTell us about your work experienceBegin with the most recent employer.1. EmployerDate EmployedAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob TitlePhoneStarting SalaryEnding SalaryManager's NameReason for Leaving2. EmployerDate Employed Address Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneJob TitleStarting Salary Ending Salary Manager's Name Reason for Leaving 3. EmployerDate Employed Address Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneJob TitleStarting Salary Ending Salary Manager's Name Reason for Leaving PreviousNextTell us about your education1. High SchoolLocationNumber of Years Completed2. College / UniversityMajor & DegreeLocationNumber of Years Completed3. Other trade or technical trainingMajor & DegreeCertificate or LicenseLocation3. Military: Branch of ServiceN/AArmyAir ForceNavyMarineCoast GuardDate of serviceDuties/Special TrainingPreviousNextWho can tell us more about you? List two professional references that are familiar with the quality of your work, have worked directly with you, and have known you at least two years.1. ReferenceRelationshipPhone2. ReferenceRelationshipPhonePreviousNextIn case of Emergency who can we contact 1. NameRelationshipContact phone number2. NameRelationship Contact phone numberPreviousNextAny additional information or skills you would like us to know?PLEASE READ BEFORE SIGNING Qualified applicants are considered for all positions without regard to race, color, religion, sex, sexual orientation, age, national origin, ancestry, transgender status, genetic information, pregnancy, marital or veteran status, disability, or any other reason prohibited by federal, state or local law. I acknowledge my responsibility to fully complete this application form accurately and truthfully. I understand that misrepresentation or omission of facts called for may result in my termination, if employed. I authorize investigation of statements made herein, including use of background checks, where applicable. Unless I noted otherwise, I authorize the Company to contact all of my employment and personal references, as well as educational institutions I have attended and obtain any records in connection therewith. I hereby release the Company and affiliated persons and entities, as well as any person or institution that provides the Company with any lawful information about me, from any and all liability whatsoever resulting from any such lawful inquiry, investigation or communication. In consideration of my employment, I agree to conform to the policies of the Company. I understand and agree that, if hired, I will be available to work the schedule required by the Company in operation of its stores and/or offices. I also agree my employment is not to be for any particular duration; is not subject to any expressed, implied or oral contract; and I may resign and my employment and compensation may be terminated at any time, with or without notice, with or without cause, at the option of either the Company or myself, without the need to follow any particular procedure, my employment is at will. I further understand the Company Handbook, as it now exists or may be revised, and other personnel-related documents I may receive now or at the time during my employment with the Company, are not an expressed or implied contract of employment or a promise of employment, and will not be regarded as such by me. I further understand the Company has the right to add to, subtract from or otherwise change compensation and benefits at any time in the future. Maryland Applicants: It is unlawful for an employer to require or demand as a condition of employment, prospective employment, or continued employment, that any individual submit to or take a polygraph, lie detector or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is subject to criminal penalties and fines. I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me. Please print a hard copy of the completed application, then sign and date with a ballpoint pen. Applicant SignatureDateSubmit