Acima Credit, LLC
Application to Join Our Team
We’re excited for you to interview with us. In order that your application may be properly evaluated, all the following questions must be answered
completely. If you need more space for your answers, please attach a separate sheet. Feel free to add any additional information, which will help us in
placing you where you are best qualified.
Name:
________________________________________________________________________________________________________
Last First Middle Initial
Home Address: ______________________________________________________________________________ (_____) _____-
______
Street City State Zip Telephone
Email Address:
______________________________________________
Other names under which you have been employed:
_________________________________________________________________
Position Information
What is the position for which you are applying?
_____________________________________________________________________
Why are you interested in this position? ____________________________________________________________________________
___________________________________________________________________________________________________________
__
___________________________________________________________________________________________________________
__
Please describe your experience in this type of role/position:
___________________________________________________________
___________________________________________________________________________________________________________
__
___________________________________________________________________________________________________________
__
On the lines below please list the three characteristics you feel are most important to success in this position. Then rate yourself on a
scale of 1 to 5 (1 being “Awesome” and 5 being “Not Good”) on how well you exemplify those characteristics.
Awesome Average Not Good
_________________________________________________________ 1 2 3 4 5
_________________________________________________________ 1 2 3 4 5
_________________________________________________________ 1 2 3 4 5
On a scale of 1 to 5 (1 being “Extremely Important” and 5 being “Not Important”) please rate the following items in terms of how
critical they are to success in this position.
Rate each item by circling one of the numbers below
Extremely Not
Important Average Important
Attendance 1 2 3 4 5
Knowledge of Acima’s products and services 1 2 3 4 5
Ability to work with co-workers 1 2 3 4 5
What is your desired wage/salary? $_ ___ per hour or $ per year
What is the earliest date you are available? ____________
How did you learn about the open position?
_______________________________________
Revised: 12/6/2017 Acima Credit
Application for Employment, Page 1 of 3
Please list employees of Acima who you personally know:
______________________________________________________________
___________________________________________________________________________________________________________
__
Why should we hire you?
________________________________________________________________________________________
___________________________________________________________________________________________________________
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___________________________________________________________________________________________________________
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Employment Profile
Please document employment history for at least the prior 5 years
May we contact your present employer? ______yes
_______no
Previous Employer: _________________________________
Address: __________________________________________
Telephone: ( ) ___________________________________
Employment Dates: From ___________ To ____________
Position Held: ______________________________________
Immediate Supervisor: _______________________________
Pay Rate: Start _______________ Finish ______________
Reason for leaving: _________________________________
Previous Employer: _________________________________
Address: __________________________________________
Telephone: ( ) ___________________________________
Employment Dates: From ___________ To ____________
Position Held: ______________________________________
Immediate Supervisor: _______________________________
Pay Rate: Start _______________ Finish ______________
Reason for leaving: _________________________________
Previous Employer: _________________________________
Address: __________________________________________
Telephone: ( ) ___________________________________
Employment Dates: From ___________ To ____________
Position Held: ______________________________________
Immediate Supervisor: _______________________________
Pay Rate: Start _______________ Finish ______________
Reason for leaving: _________________________________
Previous Employer: _________________________________
Address: __________________________________________
Telephone: ( ) ___________________________________
Employment Dates: From ___________ To ____________
Position Held: ______________________________________
Immediate Supervisor: _______________________________
Pay Rate: Start _______________ Finish ______________
Reason for leaving: _________________________________
Education
Date
Type Name and Location Major Degree Graduated Graduated
GPA
High School N/A N/A Yes No
Vocational/Technical Yes No
College/University Yes No
Graduate School Yes No
Revised: 12/6/2017 Acima Credit Application for Employment, Page 2 of 3
Professional References
I hereby authorize the following individuals to release information about my prior work history to Acima Credit: _______ (Applicant Initials) 1. Name:
____________________________________ Phone: _________________________Relationship: ____________________
2. Name: ____________________________________ Phone: _________________________Relationship:
____________________
3. Name: ____________________________________ Phone: _________________________Relationship:
____________________
Personal References 1. Name: ____________________________________ Phone: _________________________Relationship:
____________________
2. Name: ____________________________________ Phone: _________________________Relationship:
____________________
Have you ever been convicted of a criminal felony? ____yes ____no Are you legally entitled to work in the United States?
____yes ____no (Proof of eligibility required within 3 working days of employment.)
I understand, agree, and acknowledge that any employment relationship that may result from this application will be of an “at-will”
nature only, which means that I may resign at any time and for any reason and that the company may terminate my employment at
any time and for any reason or no reason, with or without cause. I also understand, agree, and acknowledge that no employee of the
company has any authority whatsoever to make any promises or arrangements with me that change the “at will” nature of any
employment relationship that may result between myself and the company.
Applicant’s Initials: _____________
In the event of my potential employment, I understand, agree, and acknowledge that; (1) any false, omitted, or misleading information
provided by me either in my résumé, on this job application form, or in interviews may result in my discharge at any time in the future;
(2) I am required to abide by all personnel policies, rules, and regulations of the company, including confidentiality, if I am hired; (3) I
authorize the investigation of all statements by the company and/or its agents contained in this application, my résumé, or made during
any interview as may be necessary in arriving at any employment decision with respect to my application; (4) this application shall be
considered active for a period of time not to exceed six months, and should I wish to be considered for employment beyond this time
period I agree to submit an additional application in the future; and (5) I authorize Acima Credit, LLC to run a background
investigational screening. I certify that all answers and information given herein are true and complete to the best of my knowledge; (6) I
release employer, and/or it’s agents and my person or entity which provides information pursuant to this authorization from any and all
liabilities, claims, and/or lawsuits in regard to the information obtained from any and all of the above-referenced sources.
Applicant’s Initials ______________
I certify that all information provided in this application is correct and accurate
Applicant’s Initials ______________
Equal Employment Opportunity Policy: It is the policy and practice of the company to abide by all anti-discrimination laws provided for
by federal, state, and local statues and regulations. It is also the policy and practice of the company to provide and promote equal
employment opportunities for all applicants and employees. It is also the policy and practice of the company to hire, train, promote,
compensate and administer all employment practices without regard to race, color, religion, sex, national origin, age, marital status,
medical condition, veteran status, sexual orientation, or disability unrelated to the ability to perform the essential functions of a job.
Furthermore, the company is committed to complying with the Americans With Disabilities Act. If you believe you need a reasonable
accommodation in order to apply for or to complete an application for employment due to the fact that you have a disability, please
notify the company within three (3) days of your application of your specific needs for a reasonable accommodation so that the
company can assist you where appropriate. If an applicant requests an accommodation for purposes of completing the job application
process, the company reserves the right to require the applicant to furnish documentation from an appropriate professional
(e.g., a doctor, rehabilitation counselor, etc.) confirming that the applicant has a disability or concerning their functional
limitations for which a reasonable accommodation is requested.
Signature: __________________________________________________ Date: ______________________________
Revised: 12/6/2017 Acima Credit Application for Employment, Page 3 of 3
