Application for Employment

Rogers Enterprises, Inc.

Applicant Information
Employment Interests

Please give an accurate, complete full-time and part-time employment record. Start with present or most recent employer.

We will contact the employers listed above unless you indicate those you do not want us to contact.
Disclosures, Authorizations, and Conditions

Disclosure: We, Rogers Enterprises, Inc., will obtain one or more consumer reports or investigative consumer reports (or both) about you for employment purposes. These purposes may include hiring, contract, assignment, promotion, re-assignment, and termination. The reports will include information about your character, general reputation, personal characteristics, and mode of living. We will obtain these reports through a consumer reporting agency. Our consumer reporting agency is General Information Services, Inc. GIS’s address is P.O. Box 353, Chapin, SC 29036. GIS’s telephone number is (866) 265-4917. To prepare the reports, GIS may investigate your education, work history, professional licenses and credentials, references, criminal record, lawsuits, driving record, credit history, and any other records with public or private information sources. You may inspect GIS’s files about you (in person, by mail, or by phone) by providing identification to GIS. If you do, GIS will provide you help to understand the files, including trained personnel and an explanation of any codes. Another person may accompany you by providing identification. If GIS obtains any information by interview, you have the right to obtain a complete and accurate disclosure of the scope and nature of the investigation performed. The Federal Trade Commission provides

Personal Information: Please print the information requested below to identify yourself for our agency.


I certify that this application was completed by me and that the facts set forth in this application are true and correct and agree that you may investigate my statements. I understand and agree that misrepresentation or omission of facts on this application will be cause for disqualification from consideration or immediate dismissal from Rogers Enterprises, Inc. at any time it becomes known. I understand and agree that as a part of the Company’s procedures for processing employment applications, an inquiry will be made which will provide applicable information concerning my past job performance. I authorize any agencies, companies, past employers, schools or persons named in this application or otherwise to give any information regarding my employment, education, conviction records or character. I hereby release the Company and said agencies, companies, past employers, schools or persons from all liability for any damage resulting from using this information. I understand and agree that my employment and, if employed, my continued employment is conditioned upon participating in and clearing such background security examinations and/or investigations as may be deemed advisable by the Company. I agree to participate in such examinations and/or investigations when requested to do so by the Company. I agree that the Company shall be held harmless and hereby release the Company from all liability that may arise in connection with any security examination and/or investigation in which I may be involved. If I am offered employment, I give my permission and will participate in a drug screening exam and consent to the release of any and all medical information as may be deemed necessary by the Company, in judging my capability to do the work for which I am applying.

I understand and agree that nothing in this employment application or in the granting of an interview creates an employment contract between the Company and myself for either employment or for the providing of any other benefit. I understand no store Manager or representative of the Company other than the President has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing.

I understand that no such promise or guarantee is binding upon the Company unless made by the Company President in writing prior to the date of this application. I understand that my employment is terminable “at will”, that is, the Company retains the right to terminate my employment at any time, with or without cause and without notice.

NOTICE TO APPLICANTS AND EMPLOYEES: screening tests for alcohol and illegal drug use may be required before hiring and during your employment.

Please keep this page for your records.

Para informacion en espanol, visite o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.


The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.
You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
a person has taken adverse action against you because of information in your credit report;
you are the victim of identify theft and place a fraud alert in your file;
your file contains inaccurate information as a result of fraud;
you are on public assistance;
you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See for additional information.
You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.
You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See for an explanation of dispute procedures.
Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.
Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.
Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need–usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.
You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to
You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).
You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.
Identity theft victims and active duty military personnel have additional rights. For more information, visit States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are:

Consumer reporting agencies, creditors and others not listed below Federal Trade Commission: Consumer Response Center – FCRA; Washington, DC 20580 1-877-382-4357
National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after bank's name) Office of the Comptroller of the Currency; Compliance Management, Mail Stop 6-6; Washington, DC 20219; 800-613-6743
Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks) Federal Reserve Consumer Help (FRCH); P O Box 1200; Minneapolis, MN 55480; Telephone: 888-851-1920;;
Savings associations and federally chartered savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name) Office of Thrift Supervision; Consumer Complaints; Washington, DC 20552; 800-842- 6929
Federal credit unions (words "Federal Credit Union" appear in institution's name) National Credit Union Administration; 1775 Duke Street; Alexandria, VA 22314; 703- 519-4600
State-chartered banks that are not members of the Federal Reserve System Federal Deposit Insurance Corporation; Consumer Response Center, 2345 Grand Avenue, Suite 100; Kansas City, Missouri 64108-2638; 877-275-3342
Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Department of Transportation; Office of Financial Management; Washington, DC 20590; 202-366-1306
Activities subject to the Packers and Stockyards Act, 1921 Department of Agriculture; Office of Deputy Administrator – GIPSA; Washington, DC 20250; 202-720-7051
If you are applying for a job or live in California, Minnesota, or Oklahoma, you may request a copy of the report by checking this box

Authorization: By signing below, you authorize: (a) GIS to request information about you from any public or private information source; (b) anyone to provide information about you to GIS; (c) GIS to provide us one or more reports based on that information; and (d) us to share those reports with others for legitimate business purposes related to your employment. You acknowledge receiving the Federal Trade Commission’s “Summary of Your Rights under the Fair Credit Reporting Act.” You acknowledge that a fax, image, or copy of this authorization is as valid as the original. You make this authorization to be valid for as long as you are an applicant or employee with us.

- or type your signature below -