APPLICATION FOR EMPLOYMENT

TO APPLICANT: We appreciate your interest in our organization and we are interested in your qualifications. A clear understanding of your
job related skills and experience would aid us in determining whether your qualifications meet our employment needs. We are an Equal
Employment Opportunity Employer. Consideration for employment is based solely on individual qualifications, without regard to race, marital
status, religious creed, color, national origin, ancestry, physical handicap, medical condition, sex, sexual orientation, age, or any other protected
category recognized by applicable federal, state and local law. This employment application is valid for a three-month period after submission
to the company and only for the desired position(s).

Name E-Mail Address

Last First M. Initial
Present Address Phone Number ( )
Street City Zip
EMPLOYEE

Can you, after employment, submit verification of your legal right to work in the United States? Yes No Are you at least 18 years of age?
Yes No
Were you previously employed by Sephora or an LVMH Company? Yes No If yes, when?
Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation? Yes No

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? Yes No If yes, state the nature of the crime(s), when and
where convicted, and disposition of the case. (Note: Convictions for marijuana-related offenses that are more than 2 years old need not be listed.)

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the
surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)
List any relatives working for Sephora:

Position(s) Applied For

POSITION

Expected Rate of Pay $ per Would you work Full-time Part-time

(32-40 hours) (under 32 hours)

Specify days and hours if part-time Days available for work?

What source referred you to Sephora?
LIST BELOW ALL PRESENT AND PAST EMPLOYMENT, BEGINNING WITH YOUR MOST RECENT.
Name of Company From To
I Month Year Month Year Summarize the Work You Did: Reason for Leaving:

Address Position: ______________________

Phone Number Starting Salary Last Salary Duties:

Name of Supervisor

Name of Company From To

II
WORK EXPERIENCE

Month Year Month Year Summarize the Work You Did: Reason for Leaving:

Address Position: ______________________

Phone Number Starting Salary Last Salary Duties:

Name of Supervisor

Name of Company From To

III Month Year Month Year Summarize the Work You Did: Reason for Leaving:

Address Position: ______________________

Phone Number Starting Salary Last Salary Duties:

Name of Supervisor

Name of Company From To

IV Month Year Month Year Summarize the Work You Did: Reason for Leaving:

Address Position: ______________________

Phone Number Starting Salary Last Salary Duties:

Name of Supervisor

May we contact the employers listed above? Yes No If no, indicate by # which one(s) you do not wish us to contact ________________
 Applicant _________________________________________________ SEPHORA – APPLICATION FOR EMPLOYMENT
OFFICE/CLERICAL Yes No
Typing WPM
Computer Hardware Platforms include:
SKILLS

Computer Software Programs include:

Other skills:
Many of our customers speak languages other than English. Please list any foreign Speak Read Write
languages that you understand and designate your ability, for each, to Speak, Read
and Write as “Poor,” “Fair,” or “Fluent.”

Are there any other experiences, skills or qualifications which you feel would contribute to the position for which you are applying?

Name & Address Course of Study Last Year Completed Did you Graduate Diploma or Degree
School (please circle)
HIGH 1 2 3 4 Yes No
EDUCATION

_____________________________________________

COLLEGE 1 2 3 4 Yes No

_____________________________________________
Presently Enrolled? Yes No

OTHER 1 2 3 4 Yes No

_____________________________________________
Presently Enrolled? Yes No

ACTIVITIES
List job-related honors and activities (including offices held). You may omit those activities or honors which indicate race, religion, creed, color, national
origin, ancestry, sex, age, marital status, disability and any other characteristic protected by applicable law.
REFERENCES

Name and Occupation Relationship Address Phone Number

Is any additional information relative to change of name, use of an assumed nickname, or nickname necessary to double check on your work record?
Yes No If yes, please explain. ________________________________________________________________________________________________
If I am employed, I agree to abide by Sephora’s rules, regulations, and policies and I agree to receive any pay earned via either Direct Deposit or Pay Card. I also agree
to receive my paystub electronically, as permitted by applicable law. I understand that my employment with Sephora will be at will, which means that either I or
Sephora may terminate the employment relationship at any time with or without cause and with or without notice. I understand that while Sephora retains the right, in
its sole discretion, to modify the terms and conditions of my employment, including my compensation, benefits, title, job duties, work schedule, and reporting
relationships, the at-will nature of my employment with Sephora can be changed only if I enter into a written agreement with Sephora signed by me and Sephora’s
Senior Vice President of Human Resources. This provision constitutes the entire agreement between me and Sephora regarding the duration of my employment, and it
supersedes any prior representations, promises, or agreements on the subject.
I certify that the facts set forth in this application for employment are true and complete. I understand that false statements or omissions on this application will result in
a refusal to hire or, if discovered after I am hired, in disciplinary action up to and including the termination of my employment.
I hereby grant permission to any person, firm or corporation to release to Sephora or its representatives any and all information regarding my past work or employment
and my background. I waive any and all claims I might have with respect to the providing of such information.
I HAVE READ THE ABOVE PRIOR TO SIGNING THIS APPLICATION.

Date of Application Signature of Applicant

Application_Stores (revised 06/09)
 Background Release Form Disclosure & Consent

In connection with my application for employment (including contract for service) with Sephora USA, Inc. (“the Company”),
I understand that investigative inquiries may be obtained on me by a consumer reporting agency, and that any such report will
be used solely for employment-related purposes. I understand that the nature and scope of this investigation will include a
number of sources including, but not limited to, consumer credit, criminal convictions, sex offender registries and public
databases, motor vehicle, and other reports. These reports will include information as to my character, general reputation,
personal characteristics, mode of living, and work habits. Information relating to my performance and experience, along with
reasons for termination of past employment from previous employers, may also be obtained. Further, I understand that the
Company will be requesting information from various Federal, State, County and other agencies that maintain records
concerning my past activities relating to my driving, credit, criminal, civil, education, and other experiences.

I understand that if the Company hires me, it may request a consumer report or an investigative consumer report about me for
employment-related purposes during the course of my employment. I understand that the scope of this investigation will be
the same as the scope of a pre-employment investigation, and that the nature of such an investigation will be my continuing
suitability for employment, or whether I possess the minimum qualifications necessary for promotion or transfer to another
position. I understand that my consent will apply throughout my employment, unless I revoke or cancel my consent by
sending a signed letter or statement to the Company at any time, stating that I revoke my consent and no longer allow the
Company to obtain consumer or investigative consumer reports about me.

I understand that I am being given a copy of the “Summary of Your Rights Under the Fair Credit Reporting Act” prepared
pursuant to 15 U.S.C. Section 1681-1681u. If I am applying for employment in the State of California or if I am a resident of
California at the time of applying for employment, a summary of the provisions of California Civil Code section 1786.22 is
also being provided to me with this form. This signed Disclosure and Consent form, whether in original, faxed, photocopied
or electronic form, will be valid for any reports that may be requested by the Company.

I authorize without reservation any party or agency contacted by the Company to furnish the above-mentioned information. I
hereby consent to the Company obtaining the above information from Accurate Background, Inc. (and/or any of their licensed
agents) located at 6 Orchard, Suite 200, Lake Forest, CA 92630, (800) 784-3911. I understand that to aid in the proper
identification of my file or records, the following personal identifiers, as well as other information, are necessary.

Print Name ________________________________________________________

Other Names Known By _______________________________________________

Social Security Number _______-_____-________ Month/Day of Birth ___/____

Driver License Number ______________________ State ___________________

Current Address ___________________________________________________

City _____________________________________ State ______ ZIP _________

Applicant Signature _______________________________ Date_______________

Prospective Employer Sephora USA, Inc.

Oklahoma or Minnesota Applicants:

I would like to receive a copy of any report obtained on me by Sephora USA, Inc. □ Yes □ No

California Applicants:
Accurate Background, Inc. must supply files and information according to applicable law. You may inspect your files or records in person
with proper identification, or by making a written request by certified mail or by telephone with proper identification. You may request to
receive a copy of any report received by Sephora USA, Inc., except for reports sought due to suspicion of wrongdoing or misconduct by
you, by checking the “yes” box. □ Yes □ No
Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response Center,
Room 130-A 600 Pennsylvania Ave., N.W , Washington, D.C. 20580.

A Summary of Your Rights Under the Fair Credit Reporting Act

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 www.ftc.gov/credit or write to: Consumer
Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W.,
Washington, D.C. 20580.

ƒ 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.
ƒ 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:
ƒ a person has taken adverse action against you because of information in your
credit report;
ƒ you are the victim of identity theft and place a fraud alert in your file;
ƒ your file contains inaccurate information as a result of fraud;
ƒ you are on public assistance;
ƒ you are unemployed but expect to apply for employment within 60 days.
In addition, by September 2005 all consumers will be entitled to one free disclosure every 12
months upon request from each nationwide credit bureau and from nationwide specialty
consumer reporting agencies. See www.ftc.gov/credit for additional information.
ƒ 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.
ƒ 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
www.ftc.gov/credit for an explanation of dispute procedures.
ƒ 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.
ƒ 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.
ƒ 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.
ƒ 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 www.ftc.gov/credit.
ƒ 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 1-888-567-8688.
ƒ 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.
ƒ Identity theft victims and active duty military personnel have additional rights. For
more information, visit www.ftc.gov/credit.
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:
TYPE OF BUSINESS: CONTACT:

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 Office of the Comptroller of the Currency
“National” or initials “N.A.” appear in or after bank’s name) Compliance Management, Mail Stop 6-6
Washington, DC 20219 1-800-613-6743
Federal Reserve System member banks (except national banks, and Federal Reserve Board
federal branches/agencies of foreign banks) Division of Consumer & Community Affairs
Washington, DC 20551 1-202-452-3693
Savings associations and federally chartered savings banks (word Office of Thrift Supervision
“Federal” or initials “F.S.B.” appear in federal institution’s name) Consumer Complaints
Washington, DC 20552 1-800-842-6929
Federal credit unions (words “Federal Credit Union” appear in National Credit Union Administration
institution’s name) 1775 Duke Street
Alexandria, VA 22314 1-703-519-4600
State-chartered banks that are not members of the Federal Reserve Federal Deposit Insurance Corporation
System Consumer Response Center, 2345 Grand Avenue, Suite 100
Kansas City, Missouri 64108-2638 1-877-275-3342
Air, surface, or rail common carriers regulated by former Civil Department of Transportation, Office of Financial Management
Aeronautics Board or Interstate Commerce Commission Washington, DC 20590 1-202-366-1306
Activities subject to the Packers and Stockyards Act, 1921 Department of Agriculture
Office of Deputy Administrator – GIPSA
Washington, DC 20250 1-202-720-7051
We Participate in E-Verify

This SWA will provide the Social Security Admin- SWA and employers may not use E-Verify to
istration (SSA) and, if necessary, the Department re-verify current employees and may not limit
of Homeland Security (DHS), or influence the choice of
with information from each N O T I C E: documents presented for use
applicant’s Form I-9 to confirm on the Form I-9.
work authorization. Federal law requires
all employers
If you believe that your SWA
to verify the identity and
IMPORTANT: If the Govern- employment eligibility has violated its responsibilities
ment cannot confirm that of all persons hired to work under this program or has
you are authorized to in the United States. discriminated against you
work, this SWA is required during the verification process
to provide you written instructions and an based upon your national origin or citizenship
opportunity to contact SSA and/or DHS before status, please call the Office of Special
taking adverse action against you, including Counsel for Immigration Related Unfair
terminating your employment. Employment Practices at 1-800-255-7688
(TDD: 1-800-237-2515).

For more information on E-Verify,

please contact DHS at:
1-888-464-4218
 IF YOU HAVE THE RIGHT TO WORK,

Don’t let anyone take it away.

If you have a legal right to You should know that – If any of these things have Call 1-800-255-7688. TDD U.S. Department of Justice
work in the United States, happened to you, you may for the hearing impaired is Civil Rights Division
there are laws to protect No employer can deny you have a valid charge of 1-800-237-2515.
you against discrimination a job or fire you because of discrimination that can be Office of Special Counsel for
in the workplace. your national origin. filed with the OSC. Contact In the Washington, D.C., Immigration-Related Unfair
the OSC for assistance in area, please call Employment Practices
Unless mandated by law your own language. 202-616-5594, TDD
or government contract, 202-616-5525
employers cannot require
you to be a U.S. Citizen or Or write to:
permanent resident or U.S. Department of Justice
refuse any legally acceptable Office of Special Counsel - NYA
documents. 950 Pennsylvania Ave., N.W.
Washington, DC 20530