TO THE APPLICANT: Kohl’s Department Stores gives all applicants for employment equal consideration
regardless of race, religion, color, sex, national origin, age, marital status, creed, physical or mental disability,
sexual orientation, or ancestry. The decision to hire an applicant is based solely on individual qualifications that
meet the job requirements. You must be at least 18 years old and must be able to show proof within the first
three days of employment, if hired, that you are legal to work in the United States.
NAME ________________________________________________________________________________ SOCIAL SECURITY # __________________________________
ADDRESS ____________________________________________________________________________________________ PHONE # ______________________________
PLEASE LIST ALTERNATE NUMBER WHERE YOU CAN BE REACHED _______________________________________________________________________________
PLEASE CHECK POSITION(S) OF INTEREST: Merchandise Processor_____ Material Handler_____ Housekeeper_______
Maintenance Mechanic____ Clerical_____ Dispatch_____ Yard Jockey_____ Other_______________________
HOURS AVAILABLE TO WORK
Have you ever worked for Kohl’s?_______ If yes, when___________________________________________________________________________________
Have you ever been convicted of, found guilty of, pled guilty to, or admitted guilt of a crime? Yes No If yes, describe in full____________________________________
Answer No for annulled, expunged or sealed records, and any youth offender and minor traffic offenses.
In California only, DO NOT answer YES if your conviction (felony or misdemeanor) involved marijuana and is more than 2 years old. DO NOT answer