Application for Employment

Welcome to the first step in joining the Dick & Jane's team.

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* 1. What is your first Name?

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* 2. What is your last Name?

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* 3. What is a telephone number you can be reached at?

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* 4. What is your email address?

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* 5. What is your street address?

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* 6. In what city do you live?

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* 7. What is your Zip Code?

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* 8. Are you over 17 years old?

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* 9. Which store do you prefer to work in?

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* 10. Why do you want to work at Dick & Jane's?

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* 11. Are there any days that you can NOT work?

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* 12. Are there any hours during the day you can NOT work?

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* 13. Please tell us about your work history.

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* 14. Tell us a little about yourself and why this is the right environment for you.

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* 15. Is there any areas you feel you have opportunity for improvement?  If so, please share.

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* 16. Do you understand that our store deals with items related to sexually specific topics and intimacy? 

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