Mitsuwa Application Form

1

Date of Application* This field is required.

Date

2

Name* This field is required.

Prefix

First Name

Middle Name

Last Name

3

Address* This field is required.

4

Position apply for* This field is required.You can make multiple choices.

Cashier/Grocery Clerk

Meat/Fish Clerk

Deli Clerk

Produce Clerk

Night Stocker

5

Phone Number* This field is required.

Area Code

Phone Number

6

Email* This field is required.

example@example.com

7

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

Yes

No

8

Position (Last employment)* This field is required.

9

Date from (Last employment)* This field is required.

Date

10

Date to (Last employment)* This field is required.

Date

11

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

Yes

No

12

Date available for work* This field is required.

Date

13

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

Full Time

Part Time

Temporary/Seasonal

14

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

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

15

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

Open (Any Time / Any Day)

Other

16

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

17

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

Yes

No

18

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

Website

Store Poster

Friend

Current Employee

19

Name of Referrer* This field is required.

Prefix

First Name

Middle Name

Last Name

20

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

21

Why are you interested in working for us?* This field is required.300 max characters

0/300

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.

23

Do you have Work Experience?* This field is required.

Yes

No

24

Employer Name 1* This field is required.

Company Name if it's applicable

25

Employer Phone Number 1* This field is required.

Area Code

Phone Number

26

Employer Address 1* This field is required.

27

Date of Employed From 1* This field is required.

Date

28

Currently Working 1* This field is required.

Yes

No

29

Date of Employed To 1* This field is required.

Date

30

Employment Category 1* This field is required.

Full Time

Part Time

Temporary/Seasonal

31

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

Flexible

Other

32

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

33

Your Last Job Title 1* This field is required.

Ex: Cashier

34

Name of Last Supervisor 1* This field is required.

Prefix

First Name

Middle Name

Last Name

35

Job duties performed 1* This field is required.

36

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

37

Reason for leaving 1* This field is required.Be specific

38

May we contact reference? 1* This field is required.

Yes

No

39

No other work history? 1* This field is required.

Yes

No

40

Employer Name 2* This field is required.

Company Name if it's applicable

41

Employer Phone Number 2* This field is required.

Area Code

Phone Number

42

Employer Address 2* This field is required.

43

Date of Employed From 2* This field is required.

Date

44

Currently working 2* This field is required.

Yes

No

45

Date of Employed To 2* This field is required.

Date

46

Employed Category 2* This field is required.

Full Time

Part Time

Temporary/Seasonal

47

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

Flexible

Other

48

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

49

Your Last Job Title 2* This field is required.

50

Name of Last Supervisor 2* This field is required.

Prefix

First Name

Middle Name

Last Name

51

Job duties performed 2* This field is required.

52

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

53

Reason for leaving 2* This field is required.Be specific

54

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

Yes

No

55

High School Name* This field is required.

56

School Address* This field is required.

58

Are you still attending?* This field is required.

Yes

No

59

No other educational background* This field is required.

Yes

No

60

School Name* This field is required.

61

School Address* This field is required.

62

Date Attended From* This field is required.

Date

63

Currently attending* This field is required.

Yes

No

64

Date Attended To* This field is required.

Date

65

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

66

Did you Graduate?* This field is required.

Yes

No

67

What is your degree obtained?* This field is required.

Diploma

Certification

Degree

Other

68

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

69

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

70

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

71

Name - Reference 1* This field is required.

Prefix

First Name

Middle Name

Last Name

72

Phone Number - Reference 1* This field is required.

Area Code

Phone Number

73

Relationship to you - Reference 1* This field is required.

74

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

75

Name - Reference 2* This field is required.

Prefix

First Name

Middle Name

Last Name

76

Phone Number - Reference 2* This field is required.

Area Code

Phone Number

77

Relationship to you - Reference 2* This field is required.

78

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

79

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

Yes

No

80

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

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.

82

Signature of Applicant* This field is required.

Clear

83

Date* This field is required.

Date

84

Applicant ID