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Personal Information

i.e. Maiden Name
2 digit state code (Example: OK)
xxx-xx-xxxx
mm/dd/yyyy
xxx-xxx-xxxx
xxx-xxx-xxxx
Yes No
mm/dd/yyyy

PLEASE READ AND SIGN THE FOLLOWING:                                              

I hereby authorize Eskimo Joe's Clothes, Inc. to deduct from my paycheck any of the following that might be applicable:                        

Any Visa, MasterCard, Discover or American Express transaction that is uncollectible due to my error
Any monetary shortages resulting from sales I am responsible for.
Any customer charges that I do not get complete billing information on (Billing information consists of a business card or complete mailing address and legible signature).
Any cost of uniforms provided to employees who do not work longer than 90 days (30 days for holiday stores).
Any cost to rekey store (up to $150) if my keys are not returned within 24 hours of my termination.

 

Throughout this form, when I type my signature, I am essentially signing this electronically.  You agree your electronic signature is the legal equivalent of your manual signature on this application.