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To apply for a store position fillout the forms below and return the completed application to the store in which you are applying. SPECIAL NOTE: The data that you type in cannot be saved. Please print your completed form.




                                                                  Retail Application for Employment
     Dollar General strives to maintain                                                                                                                            Date

     a safe and drug free environment                                                                                                                              Location/Store Number

     by conducting background
     checks and drug tests
     (as permitted by law).
                                                                                                                   Complete all areas of the application in black ink.


       PERSONAL INFORMATION
                                                                                   An incomplete or inaccurate application may delay consideration for employment.


       Full name: ______________________________________________________ Social Security Number: X X X – X X – ___ ___ ___ ___
                                              Print name as it appears on your Social Security card
       Present address: ________________________________________________________________________________________________
                                  Street                                                                                   City                                        State                  Zip code
       Primary phone: _________________________________________ Alternate phone: _________________________________________
       When is the best time to call? _____________________________ Preferred phone:
                                                                   _                  Primary    Alternate
       Email address: __________________________________________ Are you 18 years of age or older?    Yes  No
                                                      You must be at least 18 years of age to work for Dollar General unless otherwise required by law.


       GENERAL
       Do you have any relatives employed by Dollar General?                                        Yes         No
       If yes, please list name(s) and where they work: _______________________________________________________________________
       Are you legally authorized to work in the United States and able to demonstrate this by providing appropriate documentation?                                                                 Yes        No
       Will you now or in the future require sponsorship for employment visa status?                                                   Yes         No
       Have you ever been convicted of a crime (other than a minor traffic violation)?                                                 Yes         No
       (Illinois applicants: You are not obligated to disclose sealed or expunged records.)
       If yes, please explain: _____________________________________________________________________________________________
                                                           Candidates who select yes are not automatically disqualified from consideration for employment.
       How did you find out about employment opportunities at this location?
            Website                                               In-Store Signage                                      Newspaper                                Employee Walk-In
            Agency                                                Career Fair                                           College Recruiting                       Relative
            Employee Referral (Name) ______________________________________                                             Other (specify) __________________________________________


       EMPLOYMENT
       Have you ever worked for Dollar General? Yes  No If yes, where: __________________________________________________
       When: ___________ Under what name: _______________________ Reason for leaving: ____________________________________
       Position(s) desired:                                                                                        Pay Expected:
       When will you be available to begin work? ____________________ Will you have a reliable means of transportation?                                                                             Yes         No
       How many hours per week would you expect to work? __________ Are you available to work:                                                                    Part-time             Full-time
       When are you available to work?
                                 Monday                      Tuesday                 Wednesday                   Thursday                     Friday                 Saturday                   Sunday
          From
          To
       Many of our stores are open for business on holidays, weekends, and special events. While we attempt to reasonably accomodate the personal needs of our employees
       (including sincerely held religious beliefs), ultimately the work schedules are based on business needs and may be subject to change on a weekly basis.
       Do you have experience working in a distribution center or warehouse?          Yes   No
       Do you have experience working in a retail store?      Yes      No
       If applying at a store location, why do you want to work in a sales oriented environment? _____________________________________
       ______________________________________________________________________________________________________________
       What customer service experience do you have? ______________________________________________________________________

     A few of the great benefits                                                     • 401(k) Savings and Retirement Plan     • GED reimbursement program
                                                                                        • Vacation (full-time employees)    • Cash bonus for eligible positions
     Dollar General offers employees...                                                     • Health insurance for all employees (part-time & full-time)
     DG-HRIS-5010R 09/2008                                                                       • Career opportunities
Full Name                                                 Dollar General is a leading retailer with over 8,000 stores and distribution
Loc/Store#              Last 4 of SSN                   centers across the United States with a focus on Serving Others...

 WORK HISTORY
   How many different employers have you worked for in the past 5 years? _____________________________________________
   Have you ever been suspended, asked to resign or discharged from any employment?         Yes    No
   If yes, please explain: ________________________________________________________________________________________
   Please explain any gaps between employers of 3 months or longer: _________________________________________________
   Please list other names under which you worked so that Dollar General can verify your previous employment: ______________
   _________________________________________________________________________________________________________
   List below all current and past employment, beginning with your most recent.
   Industry Types: Use the following 2-digit codes to indicate the type of industry for each job listed in the work history. 01 RETAIL STORE, 02 GROCERY, 03 RESTAURANT, 04 BANKING,
   05 REAL ESTATE, 06 TRANSPORTATION, 07 CONSTRUCTION, 08 DISTRIBUTION, 09 MANUFACTURING, 10 PHARMACEUTICAL, 11 WHOLESALE DISTRIBUTION, 12 OTHER

  Company Name                                                          Industry Type        Supervisor Name                                            May we contact this employer?

  Address                                                               Phone                                                 Employed From                  Employed To

  Starting Job Title                Ending Job Title                    Reason for Leaving                                    Pay Rate Start                 Pay Rate Last

  Describe Your Work                                                    What did you like best                                What did you like least

  Company Name                                                          Industry Type        Supervisor Name                                            May we contact this employer?

  Address                                                               Phone                                                 Employed From                  Employed To

  Starting Job Title                Ending Job Title                    Reason for Leaving                                    Pay Rate Start                 Pay Rate Last

  Describe Your Work                                                    What did you like best                                What did you like least

  Company Name                                                          Industry Type        Supervisor Name                                            May we contact this employer?

  Address                                                               Phone                                                 Employed From                  Employed To

  Starting Job Title                Ending Job Title                    Reason for Leaving                                    Pay Rate Start                 Pay Rate Last

  Describe Your Work                                                    What did you like best                                What did you like least

  Company Name                                                          Industry Type        Supervisor Name                                            May we contact this employer?

  Address                                                               Phone                                                 Employed From                  Employed To

  Starting Job Title                Ending Job Title                    Reason for Leaving                                    Pay Rate Start                 Pay Rate Last

  Describe Your Work                                                    What did you like best                                What did you like least




 WORK REFERENCES Include current and accurate contact information. Do not include “personal” references.
  Name                                                                              Phone                              Alternate Phone                     Years Acquainted
                                                                                           (      )       –                   (      )          –
  Address                                                                           Email address                                              Occupation/Work Relationship

  Name                                                                              Phone                              Alternate Phone                     Years Acquainted
                                                                                           (      )       –                   (      )          –
  Address                                                                           Email address                                              Occupation/Work Relationship

  Name                                                                              Phone                              Alternate Phone                     Years Acquainted
                                                                                           (      )       –                   (      )          –
  Address                                                                           Email address                                              Occupation/Work Relationship




                                                               An Equal                                                            Employer
                                                                      Opportunity
                                                                                Dollar General does not discriminate on the basis
                                                                                 of race, sex (including pregnancy, childbirth and
                                                                                  related medical conditions), religion, color, age,
                                                                                     national origin, disability, citizenship status or
                                                                                        any other characteristic protected by law.
DG-HRIS-5010R 09/2008
EDUCATION
                                                             Full Name                              Loc/Store#         Last 4 of SSN



     School                 Name and Location of School                  Course of Study Circle completed graduate? Degree or
                                                                                         years
                                                                                                number of Did you
                                                                                                                    Diploma
   High School                                                                              1   2     3    4     Yes    No
   Vocational or                                                                            1   2     3    4     Yes    No
     Business
     College                                                                                1   2     3    4     Yes    No
    Graduate                                                                                1   2     3    4     Yes    No

Specify professional designations, certifications, licenses or registrations held related to the job(s) applied for: __________________
_____________________________________________________________________________________________________________
Issued in what state? ____________________           Expiration Date: ____________________
Check area(s) in which you are skilled/licensed:
   Cash Register              Calculator              Pricing Gun                  Baler                    Fork Lift
   Stand Up Fork Lift         Electric Pallet Jack    Manual Pallet Jack           RF Scanning Unit         Food Scale/Wrapping
   CDL                        Computer                Software (list programs): ___________________________________________________
_____________________________________________________________________________________________________________________________
   Other skills: ____________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________




        Complete the application by reading and signing the Notification and Agreement on the reverse side.
        Read the instructions for the Dollar General Desired Behaviors Assessment and complete as required.




                                                      For store use only.
Full Name

                                                                                                                                                 Loc/Store#                   Last 4 of SSN


NOTIFICATION AND AGREEMENT
  I certify that all information provided by me is true, accurate and complete. I understand that falsification, misrepresentation or omission of fact on this
  application or any other accompanying or required documents will be cause for denial of employment or immediate termination of employment, regardless
  of how or when it is discovered.
  I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information, and
  I also release the employer from all liability that might result from conducting an investigation.
  I understand that this application will remain active for a 90 day period. After that time, if I desire further consideration, I will complete a new application in
  person or by mail.
  Hiring is conditional upon, among other things, a candidate and/or employee submitting proof of identity and work eligibility in accordance with the
  Immigration Reform and Control Act, completing and obtaining successful results on a drug screen (if applicable) and criminal background check.
  You must be at least 18 years old to work for Dollar General, unless otherwise authorized by Human Resources or required by law. Close relatives
  may not work in the same store or department. No employee may work under the immediate supervision of a close relative. If you have questions
  regarding what constitutes a “close relative”, please contact a manager.
  UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR
  CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS
  PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
  I understand that this application is not a contract, offer, or promise of employment. I understand that unless otherwise agreed in writing signed by an officer of
  the Company and subject to applicable law, Dollar General employees are not hired for a specific term, and Dollar General or I may terminate my employment at
  any time with or without cause. No oral representations made by a Dollar General employee with respect to continued employment can alter this relationship.
                                   _______________________________________________________________ _______________
                                             Signature                                                                      Date
                                   _______________________________________________________________ _______________
                                           Signature                                                                                    Date
DG-HRIS-5010R 09/2008



                                                tnemssessA sroivaheB deriseD lareneG ralloD


  If you are applying for:
              Store Manager           ro   Store Manager Candidate                     .enilno detelpmoc eb tsum stnemssessA Ð                     reganaM erotS a tcatnoC

              .snoitcurtsni rof retiurceR ro       Do not complete the sections below.
              Assistant Store Manager, Lead Sales Associate       Sales Associate              dna                          si tnemssessA sroivaheB deriseD ehT Ð

                                     Complete the sections below.
              .tnemyolpme rof deriuqer



    tnemssessA sroivaheB deriseD lareneG ralloD eht detelpmoc uoy evaH                                          within the past year?               No                  Yes
 DG-HRIS-5010R 09/2008
 All fields are required for employment eligibility .
 Step 1:      :gniwollof eht etelpmoc esaelP

    First Name                                                                 Last Name                                                                           Last 4 Digits of SSN


    Month & Day of Birth                       Phone #                                                              Assessment ID                   Today’s Date
                                                (                  )


   Ex: For January 2nd: 01/02                                                                                       (on cover of DBA)               Ex: For January 2, 2008: 01/02/08

 Step 2:      eht tnemucoD .snoitcurtsni eht wollof dna ssecorp tnemssessa detamotua eht etaitini ot 8955-134-888-1 llac esaelP

              .woleb secaps eht ni metsys detamotua eht yb dedivorp # lortnoc


    Control #

 Step 3:      .derewsna eb tsum snoitseuq llA .detceles rewsna hcae rof elcric eht ni llif esaelP

          1   2   3   4   5   6   7   8    9               1   2       3   4   5   6   7   8   9            1   2   3   4   5   6   7   8   9              1   2    3   4     5   6   7   8   9

   .1                                               . 11                                             . 12                                           . 13

   .2                                               . 21                                             . 22                                           . 23

   .3                                               . 31                                             . 32                                           . 33

   .4                                               . 41                                             . 42                                           . 43

   .5                                               . 51                                             . 52                                           . 53

   .6                                               . 61                                             . 62                                           . 63

   .7                                               . 71                                             . 72                                           . 73

   .8                                               . 81                                             . 82                                           . 83

   .9                                               . 91                                             . 92                                           . 93

   . 01                                             . 02                                             . 03                                           . 04

                      Congratulations! You have completed your application for employment with Dollar General.
   FOR STORE USE ONLY                          STORE #                                               SDRADNATS STEEM                            SDRADNATS TEEM TON SEOD



DG-HRIS-5010R 09/2008

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Rea20080911bpreviewsheets Smartpdf2009 06 02

  • 1. To apply for a store position fillout the forms below and return the completed application to the store in which you are applying. SPECIAL NOTE: The data that you type in cannot be saved. Please print your completed form. Retail Application for Employment Dollar General strives to maintain Date a safe and drug free environment Location/Store Number by conducting background checks and drug tests (as permitted by law). Complete all areas of the application in black ink. PERSONAL INFORMATION An incomplete or inaccurate application may delay consideration for employment. Full name: ______________________________________________________ Social Security Number: X X X – X X – ___ ___ ___ ___ Print name as it appears on your Social Security card Present address: ________________________________________________________________________________________________ Street City State Zip code Primary phone: _________________________________________ Alternate phone: _________________________________________ When is the best time to call? _____________________________ Preferred phone: _ Primary Alternate Email address: __________________________________________ Are you 18 years of age or older? Yes No You must be at least 18 years of age to work for Dollar General unless otherwise required by law. GENERAL Do you have any relatives employed by Dollar General? Yes No If yes, please list name(s) and where they work: _______________________________________________________________________ Are you legally authorized to work in the United States and able to demonstrate this by providing appropriate documentation? Yes No Will you now or in the future require sponsorship for employment visa status? Yes No Have you ever been convicted of a crime (other than a minor traffic violation)? Yes No (Illinois applicants: You are not obligated to disclose sealed or expunged records.) If yes, please explain: _____________________________________________________________________________________________ Candidates who select yes are not automatically disqualified from consideration for employment. How did you find out about employment opportunities at this location? Website In-Store Signage Newspaper Employee Walk-In Agency Career Fair College Recruiting Relative Employee Referral (Name) ______________________________________ Other (specify) __________________________________________ EMPLOYMENT Have you ever worked for Dollar General? Yes No If yes, where: __________________________________________________ When: ___________ Under what name: _______________________ Reason for leaving: ____________________________________ Position(s) desired: Pay Expected: When will you be available to begin work? ____________________ Will you have a reliable means of transportation? Yes No How many hours per week would you expect to work? __________ Are you available to work: Part-time Full-time When are you available to work? Monday Tuesday Wednesday Thursday Friday Saturday Sunday From To Many of our stores are open for business on holidays, weekends, and special events. While we attempt to reasonably accomodate the personal needs of our employees (including sincerely held religious beliefs), ultimately the work schedules are based on business needs and may be subject to change on a weekly basis. Do you have experience working in a distribution center or warehouse? Yes No Do you have experience working in a retail store? Yes No If applying at a store location, why do you want to work in a sales oriented environment? _____________________________________ ______________________________________________________________________________________________________________ What customer service experience do you have? ______________________________________________________________________ A few of the great benefits • 401(k) Savings and Retirement Plan • GED reimbursement program • Vacation (full-time employees) • Cash bonus for eligible positions Dollar General offers employees... • Health insurance for all employees (part-time & full-time) DG-HRIS-5010R 09/2008 • Career opportunities
  • 2. Full Name Dollar General is a leading retailer with over 8,000 stores and distribution Loc/Store# Last 4 of SSN centers across the United States with a focus on Serving Others... WORK HISTORY How many different employers have you worked for in the past 5 years? _____________________________________________ Have you ever been suspended, asked to resign or discharged from any employment? Yes No If yes, please explain: ________________________________________________________________________________________ Please explain any gaps between employers of 3 months or longer: _________________________________________________ Please list other names under which you worked so that Dollar General can verify your previous employment: ______________ _________________________________________________________________________________________________________ List below all current and past employment, beginning with your most recent. Industry Types: Use the following 2-digit codes to indicate the type of industry for each job listed in the work history. 01 RETAIL STORE, 02 GROCERY, 03 RESTAURANT, 04 BANKING, 05 REAL ESTATE, 06 TRANSPORTATION, 07 CONSTRUCTION, 08 DISTRIBUTION, 09 MANUFACTURING, 10 PHARMACEUTICAL, 11 WHOLESALE DISTRIBUTION, 12 OTHER Company Name Industry Type Supervisor Name May we contact this employer? Address Phone Employed From Employed To Starting Job Title Ending Job Title Reason for Leaving Pay Rate Start Pay Rate Last Describe Your Work What did you like best What did you like least Company Name Industry Type Supervisor Name May we contact this employer? Address Phone Employed From Employed To Starting Job Title Ending Job Title Reason for Leaving Pay Rate Start Pay Rate Last Describe Your Work What did you like best What did you like least Company Name Industry Type Supervisor Name May we contact this employer? Address Phone Employed From Employed To Starting Job Title Ending Job Title Reason for Leaving Pay Rate Start Pay Rate Last Describe Your Work What did you like best What did you like least Company Name Industry Type Supervisor Name May we contact this employer? Address Phone Employed From Employed To Starting Job Title Ending Job Title Reason for Leaving Pay Rate Start Pay Rate Last Describe Your Work What did you like best What did you like least WORK REFERENCES Include current and accurate contact information. Do not include “personal” references. Name Phone Alternate Phone Years Acquainted ( ) – ( ) – Address Email address Occupation/Work Relationship Name Phone Alternate Phone Years Acquainted ( ) – ( ) – Address Email address Occupation/Work Relationship Name Phone Alternate Phone Years Acquainted ( ) – ( ) – Address Email address Occupation/Work Relationship An Equal Employer Opportunity Dollar General does not discriminate on the basis of race, sex (including pregnancy, childbirth and related medical conditions), religion, color, age, national origin, disability, citizenship status or any other characteristic protected by law. DG-HRIS-5010R 09/2008
  • 3. EDUCATION Full Name Loc/Store# Last 4 of SSN School Name and Location of School Course of Study Circle completed graduate? Degree or years number of Did you Diploma High School 1 2 3 4 Yes No Vocational or 1 2 3 4 Yes No Business College 1 2 3 4 Yes No Graduate 1 2 3 4 Yes No Specify professional designations, certifications, licenses or registrations held related to the job(s) applied for: __________________ _____________________________________________________________________________________________________________ Issued in what state? ____________________ Expiration Date: ____________________ Check area(s) in which you are skilled/licensed: Cash Register Calculator Pricing Gun Baler Fork Lift Stand Up Fork Lift Electric Pallet Jack Manual Pallet Jack RF Scanning Unit Food Scale/Wrapping CDL Computer Software (list programs): ___________________________________________________ _____________________________________________________________________________________________________________________________ Other skills: ____________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Complete the application by reading and signing the Notification and Agreement on the reverse side. Read the instructions for the Dollar General Desired Behaviors Assessment and complete as required. For store use only.
  • 4. Full Name Loc/Store# Last 4 of SSN NOTIFICATION AND AGREEMENT I certify that all information provided by me is true, accurate and complete. I understand that falsification, misrepresentation or omission of fact on this application or any other accompanying or required documents will be cause for denial of employment or immediate termination of employment, regardless of how or when it is discovered. I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information, and I also release the employer from all liability that might result from conducting an investigation. I understand that this application will remain active for a 90 day period. After that time, if I desire further consideration, I will complete a new application in person or by mail. Hiring is conditional upon, among other things, a candidate and/or employee submitting proof of identity and work eligibility in accordance with the Immigration Reform and Control Act, completing and obtaining successful results on a drug screen (if applicable) and criminal background check. You must be at least 18 years old to work for Dollar General, unless otherwise authorized by Human Resources or required by law. Close relatives may not work in the same store or department. No employee may work under the immediate supervision of a close relative. If you have questions regarding what constitutes a “close relative”, please contact a manager. UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. I understand that this application is not a contract, offer, or promise of employment. I understand that unless otherwise agreed in writing signed by an officer of the Company and subject to applicable law, Dollar General employees are not hired for a specific term, and Dollar General or I may terminate my employment at any time with or without cause. No oral representations made by a Dollar General employee with respect to continued employment can alter this relationship. _______________________________________________________________ _______________ Signature Date _______________________________________________________________ _______________ Signature Date DG-HRIS-5010R 09/2008 tnemssessA sroivaheB deriseD lareneG ralloD If you are applying for: Store Manager ro Store Manager Candidate .enilno detelpmoc eb tsum stnemssessA Ð reganaM erotS a tcatnoC .snoitcurtsni rof retiurceR ro Do not complete the sections below. Assistant Store Manager, Lead Sales Associate Sales Associate dna si tnemssessA sroivaheB deriseD ehT Ð Complete the sections below. .tnemyolpme rof deriuqer tnemssessA sroivaheB deriseD lareneG ralloD eht detelpmoc uoy evaH within the past year? No Yes DG-HRIS-5010R 09/2008 All fields are required for employment eligibility . Step 1: :gniwollof eht etelpmoc esaelP First Name Last Name Last 4 Digits of SSN Month & Day of Birth Phone # Assessment ID Today’s Date ( ) Ex: For January 2nd: 01/02 (on cover of DBA) Ex: For January 2, 2008: 01/02/08 Step 2: eht tnemucoD .snoitcurtsni eht wollof dna ssecorp tnemssessa detamotua eht etaitini ot 8955-134-888-1 llac esaelP .woleb secaps eht ni metsys detamotua eht yb dedivorp # lortnoc Control # Step 3: .derewsna eb tsum snoitseuq llA .detceles rewsna hcae rof elcric eht ni llif esaelP 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 .1 . 11 . 12 . 13 .2 . 21 . 22 . 23 .3 . 31 . 32 . 33 .4 . 41 . 42 . 43 .5 . 51 . 52 . 53 .6 . 61 . 62 . 63 .7 . 71 . 72 . 73 .8 . 81 . 82 . 83 .9 . 91 . 92 . 93 . 01 . 02 . 03 . 04 Congratulations! You have completed your application for employment with Dollar General. FOR STORE USE ONLY STORE # SDRADNATS STEEM SDRADNATS TEEM TON SEOD DG-HRIS-5010R 09/2008