We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability or any other legally protected status.

Personal Information

First Name Middle Name Last Name Address City State Zip Code Phone Number E-mail Are you under the age of 18? Yes   No If hired, on what date will you be available to work? Do you know anyone or have any relatives employed by Straub's? Yes   No If yes... Name Relationship Which Location? Central West End Clayton Ellisville Town & Country Webster Groves

Education Information	High School Name Location Years Completed 9   10   11   12 Did you Graduate? Yes   No Degree/Course of Study College Name Location Years Completed 1   2   3   4   5+ Did you Graduate? Yes   No Degree/Course of Study Other Name Location Did you Graduate? Yes   No Degree/Course of Study

Job Information	What Prompted Your Application? Agency Own Accord Employee Referral Advertising Other Position(s) Applying For: Position Expected Pay Rate Position Expected Pay Rate Do you want... Full-Time   Part-Time Specify days & hours you are available to work: Mon  Tues  Wed  Thurs  Fri  Sat  Sun

Work History	List Present Employer/Most Recent Employer First Company Name Supervisor Address City State Zip Code Phone Dates Employed From To Rate of Pay Start Last State Job Title & Describe Your Work Reason For Leaving Company Name Supervisor Address City State Zip Code Phone Dates Employed From To Rate of Pay Start Last State Job Title & Describe Your Work Reason For Leaving Company Name Supervisor Address City State Zip Code Phone Dates Employed From To Rate of Pay Start Last State Job Title & Describe Your Work Reason For Leaving May We Contact These Employers? Yes   No

Legal History	Have you ever been convicted of, or pleaded guilty to a felony? Yes   No If yes, decribe in full. Convictions will not necessarily disqualify an applicant from employment.

Other Comments	Occasionally the form of an application blank makes it difficult for individuals to adequately summarize their complete background. With that in mind please list any other special skills or qualifications that you would like us to consider.

Important: Read Carefully

I authorize present and former employers, and individuals I have listed as personal references, to furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, herby releasing them from any and all liability for damages arising from furnishing the requested information. I certify that the information contained in this application is correct to the best of my knowledge. If employed, I understand that the falsification of this information may result in my dismissal. I authorize the investigation of all statements contained in this application for employment as necessary in arriving at an employment decision. I understand that my employment may be terminated, with or without notice, by the Company for any reason, including lack of work, unsatisfactory performance, improper behavior or any other reason which, in the sole judgment of the Company, constitutes a basis for termination of employment.