CAREERS Hippies Heaven 433 S Locust Street Centralia, IL 62801 DOB: Full Name: Address: Phone: Email: WORK HISTORY Employer: Address: Phone: Dates of Employment: Employer: Address: Phone: Dates of Employment: CRIMINAL BACKGROUND: Have you ever been convicted of a felony or misdemeanor? YES NO Upon being accepted for a position with Hippies Heaven, do you consent to a background check? (Y/N) YES NO Hippies Heaven is an equal opportunity employer. By signing this application you agree that all information provided in the application is known to be true at the time of applying. In the event information changes during my screening or employment I agree to update Hippies Heaven with any and all accurate data related to my employment application, screening and duration of employment if accepted. Hippies Heaven is an “at will” employer. I agree by signing this application that I understand that “at will” means that Hippies Heaven can release me for Applicant Name Date: Send