RadioShack Job Application Form

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Radio Shack Job Application

The RadioShack job application is for any entry or management level position at a retail store in the United States. It is better if the applicant has broad knowledge about today’s technology or if he or she has any experience working in a similar environment.

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EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER

 

 

APPLICATION FOR AT-WILL EMPLOYMENT

 

050-3006 Rev. 7/05

 

 

FOR COMPANY USE

 

Unit Applied at:  Starting Date:    Job Title:     Unit Hired at:       Starting Rate:     Social Security Number:    Job Code:

PLEASE COMPLETE FULLY PRINT CLEARLY. READ DISCLOSURE STATEMENTS ON PAGE 3 BEFORE COMPLETING APPLICATION.

 

 

Name

Last First Middle

 

Please indicate any other names under which you have worked:

 

Address

Number Street Apt #

 

City State Zip Code

 

Home Phone Number ( )

 

Office Phone Number ( )

Cellular Phone Number ( )

 

Name of person where message can be left:

Message Phone Number    ( )

 

Are you under 18 years of age? Yes No

 

 

Were you previously employed by RadioShack Corporation  (formerly Tandy Corporation) or one of its subsidiaries? If yes:

Yes No

What dates? From   To  Where?

 

What position? What division or subsidiary?

If not, have you previously applied at any RadioShack (or Tandy) location? If yes:

 

Yes No

Date?   Location? Division or subsidiary?

 

Have you been convicted of a felony in the past 7 years? (Applicants seeking employment in Hawaii do not answer yes or no, please choose Not Applicable – Hawaii) (Responding yes to this preliminary question does not necessarily preclude you from being considered for employment.  However, eligibility for employment will be based upon the information contained in your criminal report to the extent allowed by law.)

Yes No

Not Applicable  – Hawaii

If yes, describe in detail:

 

Are you authorized to work in the United States? Yes No

 

EMPLOYMENT INTEREST

 

Position Applying For: Full Time Part Time Seasonal/Temporary Earnings Required: 

$  hr / wk / annual

Available to Start:
Hours Available Each Day Sunday Monday Tuesday Wednesday Thursday Friday Saturday Total HoursPer Week
A.M.
P.M.

 

We Are Proud To Be A Drug-Free Workplace

Starting with the PRESENT or MOST RECENT, list all previous employers. Include self-employment, military service, summer and part-time  jobs. If you need more space, continue on a separate sheet.

 

1  EMPLOYER
Name of Company From Describe Your Position and Duties Starting Salary Reason for Leaving Name and Title ofImmediate Supervisor
Mo. Yr.
Address
To Ending Salary
City, State, Zip Mo. Yr.
Phone No. Type of Business May We Contact Yes No
Explain Periods Between Jobs:
2  EMPLOYER
Name of Company From Describe Your Position and Duties Starting Salary Reason for Leaving Name and Title ofImmediate Supervisor
Mo. Yr.
Address
To Ending Salary
City, State, Zip Mo. Yr.
Phone No. Type of Business May We Contact Yes No
Explain Periods Between Jobs:
3  EMPLOYER
Name of Company From Describe Your Position and Duties Starting Salary Reason for Leaving Name and Title ofImmediate Supervisor
Mo. Yr.
Address
To Ending Salary
City, State, Zip Mo. Yr.
Phone No. Type of Business May We Contact Yes No
Explain Periods Between Jobs:
4  EMPLOYER
Name of Company From Describe Your Position and Duties Starting Salary Reason for Leaving Name and Title ofImmediate Supervisor
Mo. Yr.
Address
To Ending Salary
City, State, Zip Mo. Yr.
Phone No. Type of Business May We Contact Yes No
Explain Periods Between Jobs:
BUSINESS REFERENCES
Name and Title Company Phone Number( )
Name and Title Company Phone Number( )
Name and Title Company Phone Number( )

 

2

 

YearsAttended Graduated? Degree or Diploma
High School (Name, City, State) Yes No
College (Name, City, State) to Yes Mo. / Yr.   No
Post Graduate (Name, City, State) to Yes Mo. / Yr.   No
Business or Trade (Name, City, State) to Yes Mo. / Yr.   No

 

SPECIAL SKILLS

 

 

 

List any special training, skills, hobbies, or interests you believe help qualify you for the position applied for:

 

 

 

 

Software Knowledge:

 

 

 

CERTIFICATION AND AGREEMENT

Please read carefully before signing.

 

 

• I certify that the information contained in this application is true and correct to the best of my knowledge and understand that any false statement or omission on this application is grounds for rejection of my application or, if discovered after I am employed, termination.

 

• I consent and authorize RadioShack Corporation to conduct an investigation, including but not limited to, verification of  employ- ment-related information. I understand that further information concerning the nature and scope of such investigation, if one is made, is available to me upon request. I hereby authorize all previous employers to release any information they may have concerning me, excluding medical information, and I release all such employers for any and all liability arising out of the release of such information to RadioShack Corporation. I understand that the information provided in this application will be used solely for determining my eligibility for employment.

 

• In  accordance  with  RadioShack Corporation’s  drug-free  workplace  policy,  applicants  being  considered for  employment in designated positions or within designated markets must satisfactorily pass a urine test conducted at a local medical facility for the purpose of determining the presence of illegal drugs. I understand if I am selected for consideration of employment in a designated position or market, I will be provided complete details regarding the testing procedures and have an opportunity to execute authorization and consent forms prior to any testing.

 

• I understand and agree that if an offer of employment is made, I must provide documentation evidencing my authorization to work in the United States, in accordance with the Immigration Reform and Control Act of 1986, as amended.

 

• I understand and agree that  if  employed, I will be an employee at  will. As an employee at  will: (1) either RadioShack Corporation or I may terminate the employment relationship at any time, with or without cause; and (2) there is no agreement, express or implied, between RadioShack Corporation and me for any specific period of employment or for continuing or long- term employment. I understand and agree that if hired my at will employment with RadioShack Corporation may only be modified by a separate written document signed by me and an executive officer of RadioShack Corporation.

 

 

 

Signed

 

APPLICANT SIGNATURE

Date

 

 

 

3

 

FOR INTERVIEWER’S USE

(TO BE COMPLETED FOR ALL APPLICANTS)

 

NAME OF INTERVIEWER DATE EVALUATION COMMENTS

 

SKILLS PROFICIENCY RESULTS

 

SKILL ASSESSMENTS DATE RAW SCORE NET SCORE SKILL ASSESSMENTS DATE RAW SCORE NET SCORE

 

 

EMPLOYMENT VERIFICATION AND REFERENCE INFORMATION

 

EMPLOYER DATES OF EMPLOYMENT JOB TITLE REASON FOR LEAVING
1
2
3
ADDITIONAL NUMBER
ADDITIONAL NUMBER

WORK OPPORTUNITY TAX CREDIT/ WELFARE TO WORK

 

 

FOR USE WITH

8850

 

TO APPLICANT:

 

We need your help! In 1996 Congress passed legislation that gave employers a credit against their federal income tax liability for hiring certain employees.  This credit, named the Work Opportunity Tax Credit, was established to increase employment opportunities for specific target groups.  Some of these groups include individuals  who  have  participated  in  state  rehabilitation  programs,  or  people involved in government assistance programs such as food stamps.   For more information pleas refe tth “Privac Ac an Paperwor Reduction Act Notice on the back of the Form 8850.

 

 

We request that all prospective employees complete and sign the Form 8850 and the Survey/Release Form.  The purpose of this form is to identify and verify tax credits for this company and is not intended to determine your work eligibility.

 

 

TO EMPLOYER Before mailing to TALX please check the following: Applicant signed and dated the 8850 Form.

Applicant signed and dated the Survey/Release Form.

Attach a copy of the applicant’s Driver’s License or State I.D. Follow usual procedures for reporting new hires to TALX.

 

If you have any questions call TALX at 1-800-527-8582.

 

 

TALX

P.O. BOX 802233

Dallas, T 75380-2233

 

 

 

Rev. 6-9-06

IMPORTANT:  DO NOT DETACH FROM 8850. MAIL IN IMMEDIATELY WITH ORIGINAL SIGNATURE.

 

TALX SURVEY / RELEASE FORM

 

Company

Branch or Location Number

 

PLEASE COMPLETE THE FOLLOWING SURVEY AND RELEASE FORM

Name Social Security Number Date of Birth (If Under Age 25)
Current Address City & State ZIP Code
Position Applying For Have You Ever Worked ForThis Company Before?

 

1.  I am a member of a family that received AFDC or TANF: YES NO NOT SURE(AFDC = Aid to Families with Dependent Children /TANF = Temporary Assistance for Needy Families)a.  for at least 9 months within the last 18 months

 

b.  for the last 18 months in a row

 

c.  for any 18 months after August 5, 1997

 

d.  stopped receiving within the last2 years because the benefits ran out.

 

2.  I have received Supplemental Security Income (SSI) for at least

 

1 month within the last 3 months.

 

3.  I am a member of a family that received Food Stamps:

 

a.  the last 6 months

b.  3 out of the last 5 months & no longer eligible to receive it.

 

4.  I am a Military Veteran and a member of a family that received

Food Stamps for at least 3 months within the last 15 months.

 

If You Checked “Yes” or “Not Sure” To Any Question Above, Complete the Information Requested Below and Continue Survey.

County of Benefits City & State of Benefits Primary Recipient (Name & Social Security Number)
Case Worker Name Case Worker Phone Number Case Number
Branch of Military Service Military ID Number Entrance Date Discharge Date

 

5.  I am currently enrolled in or have completed a State or Veteran sponsored YES NO NOT SUREVocational Rehabilitation Program.If You Checked “Yes” or “Not Sure” To Any Question Above, Complete the Information Requested Below and Continue Survey.
Counselor Name Counselor Phone Number Counselor Address
City, State & ZIP Code (of Program) County of Program Name of Agency

 

6.  I was convicted of or released from prison for a Felony within the last year YES NO NOT SUREor I am in a Pre-Release Program.If You Checked “Yes” or “Not Sure” To Any Question Above, Complete the Information Requested Below and Continue Survey.
Parole/Probation Officer Name Parole/Probation Officer Phone Number Number of Family Living WithYou, Including You Your Income For Last 6 Months
Date Convicted Date Released City, State & County of Conviction City, State & County of Release

 

STATEMENT OF RELEASE

I hereby authorize that verification of the information above be released to my employer, or TALX, or State Employment Security Agencies (S.E.S.A.), or State Workforce Agencies (S.W.A.), or a required federal or state agency (such as Social Security Administration for Supplemental Security Income for the dates requested) for the purpose of enabling my employer to apply for various federal and state tax credits, including the Work Opportunity Tax Credit (WOTC) or Welfare-to-Work Credit. These programs encourage affirmative action to hire certain categories of employees. Information will be kept confidential in accordance with EEOC guidelines and the Americans with Disabilities Act.

 

 

APPLICANT/EMPLOYEE SIGNATURE 

DATE 

 

 

 

Rev. 12/05

RETURN ALL FORMS TO:

TALX, P.O. Box 802233, Dallas, TX 75380-2233

Form   8850

(Rev. October 2002)

Department of the Treasury

Internal Revenue Service

 

Pre-Screening  Notice  and Certification Request  for the Work Opportunity  and Welfare-to-Work Credits

 

?   See separate instructions.

 

 

 

OMB No. 1545-1500

 

 

Job applicant: Fill in the lines below and check any boxes that apply. Complete only this side.

 

 

Your name

Social security number  ?

 

Street address where you live

 

City or town, state, and ZIP code

 

Telephone number ( ) –

 

If you are under age 25, enter your date of birth (month, day, year)

/ /

 

 

Work Opportunity Credit

 

 

1 Check here if you received a conditional certification from the state employment security agency (SESA) or a participating local agency for the work opportunity credit.

 

2 Check here if any of the following statements apply to you.

 

●    I am a member of a family that has received assistance from Temporary Assistance for Needy Families (TANF) for any

9 months during the last 18 months.

 

●    I am a veteran and a member of a family that received food stamps for at least a 3-month period within the last 15 months.

 

●    I was referred here by a rehabilitation agency approved by the state or the Department of Veterans Affairs.

 

●    I am at least age 18 but not age 25 or older and I am a member of a family that:

 

a Received food stamps for the last 6 months or

 

b Received food stamps for at least 3 of the last 5 months, but is no longer eligible to receive them.

 

●    Within the past year, I was convicted of a felony or released from prison for a felony and during the last 6 months I

was a member of a low-income family.

 

●    I received supplemental security income (SSI) benefits for any month ending within the last 60 days.

 

Welfare-to-Work Credit

 

 

3 Check here if you received a conditional certification from the SESA or a participating local agency for the welfare-to-work credit.

4 Check here if you are a member of a family that:

●    Received TANF payments for at least the last 18 months, or

●    Received TANF payments for any 18 months beginning after August 5, 1997, and the earliest 18-month period beginning after August 5, 1997, ended within the last 2 years, or

●    Stopped being eligible for TANF payments within the last 2 years because Federal or state law limited the maximum time those payments could be made.

 

All Applicants

 

Under penalties of perjury, I declare that I gave the above information to the employer on or before the day I was offered a job, and it is, to the best of my knowledge, true, correct, and complete.

 

Job applicants signature ?

 

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

 

 

Cat. No. 22851L

 

Date / /

Form 8850 (Rev. 10-02)

 

Form 8850 (Rev. 10-02)

Page 2

 

 

For Employers Use Only

 

Employer’s name

Telephone no.

( ) –

EIN  ?

 

Street address

 

City or town, state, and ZIP code

 

Person to contact, if different from above

Telephone no.

( ) –

 

Street address

 

City or town, state, and ZIP code

 

If, based on the individual’s age and home address, he or she is a member of group 4 or 6 (as described under Members

of Targeted Groups in the separate instructions), enter that group number (4 or 6) ?

 

 

Date applicant:

 

Gave

information / /

Was offered

job / /

 

Was

hired / /

 

Started

job / /

Under penalties of perjury, I declare that I completed this form on or before the day a job was offered to the applicant and that the information I have furnished is, to the best of my knowledge, true, correct, and complete. Based on the information the job applicant furnished on page 1, I believe the individual is a member of a targeted group or a long-term family assistance recipient. I hereby request a certification that the individual is a member of a targeted group or a long-term family assistance recipient.

 

Employers signature ?

Title Date / /

 

Privacy Act and Paperwork Reduction Act Notice

Section references are to the Inter nal

Revenue Code.

Section 51(d)(12) permits a prospective employer to request the applicant to complete this form and give it to the prospective employer. The information will be used by the employer to complete the employer’s Federal tax return. Completion of this form is voluntary and may assist members of targeted groups and long-term family assistance recipients in securing employment. Routine uses of this form

include giving it to the state employment security agency (SESA), which will contact appropriate sources to confirm that the applicant is a member of a targeted group or a long-term family assistance recipient. This form may also be given to the Internal Revenue Service

for administration of the Internal Revenue laws, to the Department of Justice for civil and criminal litigation, to the Department of Labor for oversight of the certifications performed by the

SESA, and to cities, states, and the District of Columbia for use in administering their tax laws. In addition, we may disclose this information to Federal, state, or local agencies that investigate or respond to acts or threats of terrorism or participate in intelligence or counterintelligence activities concerning terrorism.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records

relating to a form or its instructions must be retained as long as their contents

may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103.

The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is:

Recordkeeping   2 hr., 46 min.

Learning about the law

or the form 36 min.

Preparing and sending this form

to the SESA   36 min. If you have comments concerning the

accuracy of these time estimates or

suggestions for making this form

simpler, we would be happy to hear from you. You can write to the Tax Forms Committee, Western Area Distribution Center, Rancho Cordova, CA

95743-0001.

Do not send this form to this address. Instead, see When and Where To File in the separate instructions.

 

 

 

 

 

 

 

Form 8850 (Rev. 10-02)

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