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Note: Applicants submitting this form may be asked to complete a full application during the live interview process.

I. Personal Information

Upon hire, you will be required to present proof of age, authorization to work and your social security number.


II. Employment Interest



III. Education

School level Name and location Did you graduate? Degree/certification
High School YES
College YES
Other YES

IV. Former Employers

Please account for the past five years of employment by answering questions for each employer.

Present Employer Previous Employer Previous Employer
Company Name
Company Phone Number
Company Address
Starting/Ending Rate of Pay
Start Date and Date Last Worked
May we contact your supervisor? If not, why?
Supervisor Name and Title
Summarize job responsibilities
Reason(s) for leaving
If you were terminated or asked to resign, please explain

V. Employment Gaps

Explain any periods that you were not working during the past 10 years other than due to personal illness, injury, or disability.

VI. References

List name and telephone number of three business/work references who are NOT related to you and are NOT previous supervisors. If not application, list three personal references who are NOT related to you.

Name Title Relationship Phone Years Known

VII. Job Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying. If driving is required for the job you are applying for, please provide your valid driver's license number, expiration date, and state of issuance.

VIII. Related Information

If you are a member of any job-related organizations (professional, trade, etc) or have received any job-related awards or accomplishments, list and describe them. Exclude any information that would reveal your age, race, sex, religion, color, national origin, ancestry, marital status, disability, sexual orientation, arrest and court or any other protected category recognized by Hawaii and federal laws.