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Tracking# PAGE of <br /> Voluntary Statement <br /> Name: .) �1��Y11� V I��Q1 _ ?.ssociate ID #: d10 <br /> ManthlDay of Birth: /�� <br /> Store#; �a Stare Location: U 1 �it+ Date of Hire: 1�_I �Q <br /> Home Address: ` L City: L C i State: 04 ,Zip:qr2-1-(-) <br /> Home Phone: { ) - Mobile Phone: (LL7j_) - 5 Email: YQtiYaS-EG(�rtc�Yll� lUi'"�y�t}LCg� <br /> W <br /> CU+"l <br /> Today's Date: _lIq / 2o?o <br /> ' Statement Start Time- Statement End Time: <br /> -------------------------------------------------------------- --- ---------------------------------------------------------------------------------------------- <br /> I, V-A e - <br /> %W mace this voluntary statement to \jCYQnkCCA, ApOd Gt T have been <br /> employed by Dick's Sporting Goods as a(title) ClaSl�ince—L/ IU/ 2C)2-0 <br /> JO U191202-0 *eAS VO Ue- OMS MS S)4"e-d \n. <br /> 2 b 1) e i n b �\1 :,fW, L OYl <br /> 3 <br /> 4 00 <br /> )E�Q- V — OUY <br /> ct� <br /> 6 \M[kS VL l Y`a+ -1 ►1[ `CJ tJl� hl A- _Al�e, <br /> 7 \ CI r 0 e. CwlinjeQ� <br /> 8 2 LU D I rio fo . d.j..j O <br /> Y k e oU <br /> a <br /> 16 e Q he, <br /> v 5k -� vin Q� <br /> h 6k-r CGU s e <br /> 12 ; l.J 1 J L V W< <br /> S' ure Date Print Name Date <br /> 1 1 1 1 <br /> Interviewer Signature Date Print Name Date <br /> Witness Signature Date Print Name Date <br /> Dick's Entities include:Dick's Sporting Goods,Inc.;Golf Galaxy LLC;True Runner Stores Chelsea Collective and Field&Stream Stores <br /> Revised 05/2018 <br />