Employment Application

Job Application Form

First Name

Last Name

Middle Name

Street Address

Address 2

City

State

Zip Code

May we contact you here?

Yes

Cellular Phone

Home Phone

Business Phone

Emergency Contact Name

Relationship

Phone Number

Position Applying For and Site Location:

Date Available to Work

Salary Expected

PLEASE INITIAL: I understand that an offer of employment and my continued employment with The Simon Companies, LP are contingent upon satisfactory proof of my authorization to work in the United States

If needed, will you be required to obtain a work permit in the United States?

Yes

If you are a veteran of any branch of the U.S. Armed Forces, did you acquire skills that would be relevant for the position for which you are applying?

Yes

If yes, please describe:

Are you 18 years of age or older?

Yes

Type of employment desired:

Full-Time

Part-Time

Have you ever been employed by the Company?

Yes

If yes, specify the dates

How were you referred to the company?

Are you willing to travel?

Yes

If yes, percentage of time?

Are you willing to relocate?

Yes

Education

Institution Name and Location

Type of Degree

Graduated?

Yes

Major Field of Study

List any special skills, experiences, training and/or other qualifications that could potentially enhance your ability to perform the position you are applying for (i.e., certifications, computer software knowledge, professional recognitions).

Employment History

Please list your complete full-time and part-time employment history, including self-employment. List the last position first and account for any lapse between employment periods. You may include any verifiable work performed on a volunteer basis. Please also include U.S. military service, temporary assignments, and cooperative education work.

All employers, including your current employer, may be contacted to verify the information you provide. May we contact your current employer prior to any offer of employment?

Yes

Company Name, Address and Phone Number	Date Employed Month/Year	Name, Title, and Phone Number of Immediate Supervisor	Job Title and Work Responsibilities	Reason for Leaving

Personal References

Please provide the names of individuals who can appraise your professional qualifications. Include, as appropriate, any supervisors (present and/or past), professional peers, etc. Business references are preferred. Please do not include any individuals related to you.

Reference(s)

Name and Occupation	Company and Address	Telephone Number	Years Known and Capacity

Additional Employment Inquiries

Are you currently subject to any non-competition, non-solicitation or other restrictive covenants with a former employer (other than a covenant requiring you not to release confidential information)?

Is there anything else you feel the Company should know about you that would positively influence the Company to hire you?

*IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY. THIS APPLICATION IS NOT COMPLETE UNTIL IT IS FULLY COMPLETED, SIGNED, AND ALL STATEMENTS BELOW HAVE BEEN READ AND INITIALED.

I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts may result in refusal to hire or, if hired, may result in termination of my employment at any time regardless of when the false answer or omission is discovered.

I understand that this employment application is not an offer of employment. I understand that if I am hired by the Company, my employment will be at-will, which means the employment is for no definite period and may be terminated by me or the Company at any time with or without cause or advance notice. I further understand that neither this application, nor any other verbal communication from the Company is intended to create an employment contract, and that no representative of the Company has the authority to make any assurances to the contrary. I also understand that no representative of the Company has the authority to make any assurances to the contrary. I also understand that no representative of the Company, other than the President, Senior Vice President or the President's authorized representative, has the authority to enter into any agreement for employment for a specified duration or to make any agreement with me for employment other than at-will, and any agreement that changes at-will employment status must be explicit, in writing, and signed by both the Company President, Senior Vice President, or the President's authorized representative and me.

I understand that, if hired, my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by the Company.

I understand that if I am offered employment, I may be required to sign a non-solicitation, non-disclosure and/or non-competition agreement as a condition of employment.

I hereby authorize the Company to conduct an investigation regarding my background as it relates to the position I am seeking and to the extent permitted by federal, state, and local law. I understand that if I do not complete the requisite authorization forms for the background investigation, I will not be eligible for employment by the Company.

I understand and agree that if employed by the Company, storage areas provided to me (locker, desk, etc.) are open to inspection by the Company at any time without prior notice to me.

I agree to undergo drug testing consistent with federal and state law to the extent required for the position for which I am applying at the Company.

My signature below certifies that I agree to be bound by the terms and conditions stated in this application, which contains all the understanding between the Company and me concerning the topics addressed herein, and supersedes any prior inconsistent understanding between the Company and me on such issues.

Applicant's Signature

Date

This application will only be considered for 30 days. If you have not been hired within 30 days of submitting this application and you wish to continue to be considered for employment, you must complete another application.

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