Name*

Address*

Phone Number with Area Code*

Email Address*

Position Interested In*

Hours wanting to work*

Which store are you interested in working at*

Date you can start*

Salary Desired*

Highest Level of Education Completed*

List last 3 employers/Phone Number/Date of employment/Salary/Position/Reason for leaving*

List 3 References Name/Address/Business/Years Known (non relatives only)*

What qualifications do you have that make you a good candidate?*

Are you involved in the sport of Cycling? If so, how?*

Have you ever been convicted of any criminal offense other than minor traffic violations? Yes No

What work experience have you found most satisfying and why?*

What work experience have you found least satisfying and why?*

*By answering yes you agree that " I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative."*