Basic Information
Appying for Job :
First Name:
Middle Name:
Last Name:
Contact Detail
Address :
City:
State:
Zip:
Email Address :
Telephone:

1. GENERAL INFORMATION

Are you able to perform the essential job functions of the position for which you are applying with or without reasonableaccommodation?

Yes No

Have you been convicted of any felonies other than minor traffic violations during the past seven years? (A criminal record or aconviction will not automatically bar employment, but will be considered only as it reasonably relates to your fitness to perform in theposition for which you are applying.)

No Yes
If yes,

2. EDUCATION & TRAINING
Circle last grade completed
Grade 1 2 3 4 5 6 7 8 9 10 11 12
College 1 2 3 4
Masters
Doctorate
Name & Address of School Major course studied Graduated degree
(Yor N)
Average grade
List any scholarships, academic honors, awards or special achievements:

3. SKILLS

Please list any skills you have that are appropriate for the position you are applying for:

If required, will you work?
Rotating shifts No Yes Saturdays No Yes
Overtime No Yes Sunday No Yes
Position applying for, be specific:
Salary Requirements, be specific: per hour per month

State fully why you believe you are qualified for this position

INTERESTS / ACCOMPLISHMENTS: You may wish to list significant experience, interests & accomplishments gained while working as a volunteer or as a hobbyist that may be useful in the position(s) you are seeking. Names or organizations designating religion, race, etc. need not be mentioned.

Date you can start
EMPLOYMENT HISTORY:    

Starting with your PRESENT or MOST RECENT EMPLOYER list in consecutive order ALL EMPLOYMENT for at least the past FOUR  employers. If currently employed, may we contact your employer?

Yes NO
  PRESENT OR MOST RECENT EMPLOYER    
Employment History-1
Full name of company : Salary Employed
Telephone : Begin End From MO/YR To MO/YR
Street Address:
City:

Reason For Leaving:

State:
Zip:
NAME & TITLE OF SUPERVISOR:
TITLE OF YOUR POSITION:

LIST JOBS HELD, DUTIES PERFORMED, SKILLS USED, & PROMOTIONS WHILE EMPLOYED AT THIS COMPANY:


Employment History-2
Full name of company : Salary Employed
Telephone : Begin End From MO/YR To MO/YR
Street Address:
City:

Reason For Leaving:

State:
Zip:
NAME & TITLE OF SUPERVISOR:
TITLE OF YOUR POSITION:

LIST JOBS HELD, DUTIES PERFORMED, SKILLS USED, & PROMOTIONS WHILE EMPLOYED AT THIS COMPANY:


Employment History-3
Full name of company : Salary Employed
Telephone : Begin End From MO/YR To MO/YR
Street Address:
City:

Reason For Leaving:

State:
Zip:
NAME & TITLE OF SUPERVISOR:
TITLE OF YOUR POSITION:

LIST JOBS HELD, DUTIES PERFORMED, SKILLS USED, & PROMOTIONS WHILE EMPLOYED AT THIS COMPANY:


Employment History-4
Full name of company : Salary Employed
Telephone : Begin End From MO/YR To MO/YR
Street Address:
City:

Reason For Leaving:

State:
Zip:
NAME & TITLE OF SUPERVISOR:
TITLE OF YOUR POSITION:

LIST JOBS HELD, DUTIES PERFORMED, SKILLS USED, & PROMOTIONS WHILE EMPLOYED AT THIS COMPANY:

READ CAREFULLY: I certify that the information contained in this application is correct to the best of my knowledge and understand that any misstatement or omission ofinformation may result in denial of employment or discharge. I authorize the references listed above to give you any and all information concerning my previous employment and anypertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.



 

Hawaii Office
1718 Democrat Street
Honolulu, Hawaii 96819

Guam Office
P.O. Box 21281
Barrigada, Guam 96921

Las Vegas Office
3860 Vanessa Drive
Las Vegas, Nevada 89103
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