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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.