Mitsuwa Application Form

1

Date of Application* This field is required

Date

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2

Name* This field is required

Prefix

First Name

Middle Name

Last Name

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3

Address* This field is required

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5

Phone Number* This field is required

Area Code

Phone Number

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6

Email* This field is required

example@example.com

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7

Have you ever been employed here before?* This field is required

Yes

No

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8

Position (Last employment)* This field is required

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9

Date from (Last employment)* This field is required

Date

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10

Date to (Last employment)* This field is required

Date

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11

Are you legally eligible for employment in this country?* This field is required

Yes

No

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12

Date available for work* This field is required

Date

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13

Type of employment desired* This field is requiredYou can make multiple choices.

Full Time

Part Time

Temporary/Seasonal

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14

What is your desired salary range?* This field is required

Ex: $_._ to $_._ per Hour, $_._ to $_._ per Month

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15

Working Schedule* This field is requiredIf you picked "Other", please check your Availability (Days & Hours) on the next page

Open (Any Time / Any Day)

Other

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16

Days/hours available to work* This field is requiredPlease enter hours & days available, time frames 6am to 12am ex: Monday - 6am to 1pm

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17

Do your relatives work in our company?* This field is required

Yes

No

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18

How were you referred to us for employment?* This field is requiredYou can make multiple choices.

Website

Store Poster

Friend

Current Employee

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19

Name of Referrer* This field is required

Prefix

First Name

Middle Name

Last Name

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20

Please explain which media you found about Mitsuwa employment?* This field is required

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21

Why are you interested in working for us?* This field is required300 max characters

0/300

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22

We are sorry to inform you that we are not accepting person with no work permit. Please obtain the proper permition and try us again.

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23

Do you have Work Experience?* This field is required

Yes

No

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24

Employer Name 1* This field is required

Company Name if it's applicable

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25

Employer Phone Number 1* This field is required

Area Code

Phone Number

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26

Employer Address 1* This field is required

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27

Date of Employed From 1* This field is required

Date

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28

Currently Working 1* This field is required

Yes

No

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29

Date of Employed To 1* This field is required

Date

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30

Employment Category 1* This field is required

Full Time

Part Time

Temporary/Seasonal

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31

Working Schedule 1* This field is requiredIf you picked "Other", please check your Availability (Days & Hours) on the next page

Flexible

Other

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32

Scheduled hours worked 1* This field is requiredPlease enter hours & days worked, time frames 6am to 12am ex: Monday - 6am to 1pm

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33

Your Last Job Title 1* This field is required

Ex: Cashier

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34

Name of Last Supervisor 1* This field is required

Prefix

First Name

Middle Name

Last Name

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35

Job duties performed 1* This field is required

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36

Why did you apply for Employer? 1* This field is required

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37

Reason for leaving 1* This field is requiredBe specific

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38

May we contact reference? 1* This field is required

Yes

No

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39

No other work history? 1* This field is required

Yes

No

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40

Employer Name 2* This field is required

Company Name if it's applicable

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41

Employer Phone Number 2* This field is required

Area Code

Phone Number

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42

Employer Address 2* This field is required

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43

Date of Employed From 2* This field is required

Date

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44

Currently working 2* This field is required

Yes

No

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45

Date of Employed To 2* This field is required

Date

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46

Employed Category 2* This field is required

Full Time

Part Time

Temporary/Seasonal

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47

Working Schedule 2* This field is requiredIf you picked "Other", please check your Availability (Days & Hours) on the next page

Flexible

Other

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48

Scheduled hours worked 2* This field is requiredPlease enter hours & days worked, time frames 6am to 12am ex: Monday - 6am to 1pm

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49

Your Last Job Title 2* This field is required

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50

Name of Last Supervisor 2* This field is required

Prefix

First Name

Middle Name

Last Name

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51

Job duties performed 2* This field is required

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52

Why did you apply for Employer? 2* This field is required

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53

Reason for leaving 2* This field is requiredBe specific

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54

May we contact for reference? 2* This field is required

Yes

No

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55

High School Name* This field is required

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56

School Address* This field is required

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58

Are you still attending?* This field is required

Yes

No

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59

No other educational background* This field is required

Yes

No

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60

School Name* This field is required

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61

School Address* This field is required

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62

Date Attended From* This field is required

Date

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63

Currently attending* This field is required

Yes

No

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64

Date Attended To* This field is required

Date

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65

Major* This field is requiredIf you don't have an answer for this question, please put N/A

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66

Did you Graduate?* This field is required

Yes

No

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67

What is your degree obtained?* This field is required

Diploma

Certification

Degree

Other

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68

Please explain "Other" in brief* This field is required

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69

GPA* This field is requiredIf you don't have an answer for this question, please put N/A

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70

If you have any other work experiences/educational background, and if you are interested in another position, please state below:* This field is requiredIf you don't have any skills or qualifications, please put N/A

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71

Name - Reference 1* This field is required

Prefix

First Name

Middle Name

Last Name

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72

Phone Number - Reference 1* This field is required

Area Code

Phone Number

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73

Relationship to you - Reference 1* This field is required

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74

Number of Years Known - Reference 1* This field is required

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75

Name - Reference 2* This field is required

Prefix

First Name

Middle Name

Last Name

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76

Phone Number - Reference 2* This field is required

Area Code

Phone Number

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77

Relationship to you - Reference 2* This field is required

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78

Number of Years Known - Reference 2* This field is required

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79

Did you complete this application yourself?* This field is required

Yes

No

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80

If not, who did?* This field is requiredPlease write Name and Relationship to applicant below.

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81

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.&#13;&#10;&#13;&#10;I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.&#13;&#10;&#13;&#10;I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.&#13;&#10;&#13;&#10;I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.&#13;&#10;&#13;&#10;If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.&#13;&#10;&#13;&#10;I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.&#13;&#10;&#13;&#10;This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.&#13;&#10;&#13;&#10;I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.&#13;&#10;&#13;&#10;DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT&#13;&#10;&#13;&#10;I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

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82

Signature of Applicant* This field is required

Clear

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83

Date* This field is required

Date

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84

Applicant ID

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