APPLICATION FOR EMPLOYMENT

INSTRUCTIONS: Please complete all portions of this employment application to be considered for employment. If you require accommodation during the employment application process, including assistance in the completion of this employment application, please let us know. We are an Equal Opportunity Employer. We do not discriminate in employment opportunities or practices on the basis of race, color, religion, sex or gender, national origin, citizenship, age, disability, ancestry, sexual orientation, arrest and court record except as provided by H.R.S. §378-2.5, marital status, military/, veteran status, genetic information, credit history, status as a domestic or sexual violence victim if notice is given to us or we have actual knowledge of such status, or any other characteristic protected by law. Consideration for employment after a six-month period requires completion and submission of a new application.

PERSONAL DETAILS


LAST NAME*	FIRST NAME*
HAVE YOU EVER USED ANY OTHER NAMES? IF SO, PLEASE PRINT. (For background and criminal conviction check)
PRESENT ADDRESS*	APT NO.	CITY*	STATE*	ZIP*
PHONE*	SOCIAL SECURITY NUMBER (OPTIONAL)
CELLULAR	E-MAIL*

DESIRED EMPLOYMENT


DESIRED POSITION*	DATE YOU CAN START*	SALARY DESIRED (per year)*
HAVE YOU EVER APPLIED FOR EMPLOYMENT AT THIS COMPANY BEFORE?* YES NO	WHERE?	WHEN?
HAVE YOU EVER WORKED FOR THIS COMPANY BEFORE?* YES NO	WHERE?	WHEN?
WHO REFERRED YOU TO THIS COMPANY?*
APART FROM RELIGIOUS OBSERVANCES, WILL YOU BE ABLE TO WORK AT ALL OTHER TIMES?*		YES NO

*NOTE: if hired, you will be required to perform work as required by the Company

FORMER EMPLOYERS

Please account for the last ten years of employment.
FOR EACH EMPLOYER, YOU MUST ANSWER ALL QUESTIONS. CLICK ADD EMPLOYER FOR ADDING MORE EMPLOYERS.
In case you have no prior experience, please click "Remove the last added employer" and remove the former employers section before submitting.

Add employer >> Remove the last added employer >>

EMPLOYER 1

NAME OF PRESENT OR LAST EMPLOYER*
ADDRESS*	CITY*	STATE*	ZIP*
STARTING DATE*	DATE LAST WORKED*	JOB TITLES*
MAY WE CONTACT YOUR SUPERVISOR? YES NO IF NO, WHY?
NAME OF SUPERVISOR*	TITLE*	EMPLOYER’S PHONE NUMBER*
DESCRIPTION OF WORK:
REASON(S) FOR LEAVING, IF YOU WERE TERMINATED OR ASKED TO RESIGN, PLEASE EXPLAIN:*

EMPLOYER 2

NAME OF PRESENT OR LAST EMPLOYER*
ADDRESS*	CITY*	STATE*	ZIP*
STARTING DATE*	DATE LAST WORKED*	JOB TITLES*
MAY WE CONTACT YOUR SUPERVISOR? YES NO IF NO, WHY?
NAME OF SUPERVISOR*	TITLE*	EMPLOYER’S PHONE NUMBER*
DESCRIPTION OF WORK:
REASON(S) FOR LEAVING, IF YOU WERE TERMINATED OR ASKED TO RESIGN, PLEASE EXPLAIN:*

EMPLOYER 3

NAME OF PRESENT OR LAST EMPLOYER*
ADDRESS*	CITY*	STATE*	ZIP*
STARTING DATE*	DATE LAST WORKED*	JOB TITLES*
MAY WE CONTACT YOUR SUPERVISOR? YES NO IF NO, WHY?
NAME OF SUPERVISOR*	TITLE*	EMPLOYER’S PHONE NUMBER*
DESCRIPTION OF WORK:
REASON(S) FOR LEAVING, IF YOU WERE TERMINATED OR ASKED TO RESIGN, PLEASE EXPLAIN:*

EMPLOYER 4

NAME OF PRESENT OR LAST EMPLOYER*
ADDRESS*	CITY*	STATE*	ZIP*
STARTING DATE*	DATE LAST WORKED*	JOB TITLES*
MAY WE CONTACT YOUR SUPERVISOR? YES NO IF NO, WHY?
NAME OF SUPERVISOR*	TITLE*	EMPLOYER’S PHONE NUMBER*
DESCRIPTION OF WORK:
REASON(S) FOR LEAVING, IF YOU WERE TERMINATED OR ASKED TO RESIGN, PLEASE EXPLAIN:*

EDUCATION

SCHOOL LEVEL	NAME AND LOCATION OF SCHOOL	DID YOU GRADUATE?	SUBJECTS STUDIED
		YES NO
		YES NO
		YES NO

REFERENCES

GIVE THE NAMES OF THREE PERSONS YOU ARE NOT RELATED TO,
WHOM YOU HAVE KNOWN AT LEAST ONE YEAR AND WHOM WE CAN CONTACT.

	NAME	ADDRESS	YEARS KNOWN	PHONE NUMBER
1
2
3

JOB SKILLS, QUALIFICATIONS AND EMPLOYMENT GAPS

SUMMARIZE YOUR JOB SKILLS, TRAINING AND/OR STUDY THAT ARE RELEVANT FOR THE DESIRED POSITION. ALSO, EXPLAIN ANY PERIODS THAT YOU WERE NOT WORKING.

RESUME

Resume (Word, Text, PDF)


	By typing my name below, I certify that I have read, fully understand and accept all terms of the Certification Statement.(Opens a new window)
	DO NOT E-SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT
	Signature (Type your full name):*
	Date of Signature:
	You may wish to print this page for your records before submitting.