Employment

Personal Information

Your Name (required)

Your Email (required)

Subject

Full Name

Present Address

How long have you been at this address?

Telephone Number

Position Applying For: CashierShari MakerSushi Maker

Type of Employment: Full TimePart Time

Expected Pay Rate:

Start Date (YYYY-MM-DD):

Hours Available To Work:

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Have you ever worked for a Kozo Sushi? YesNo

If yes, when and where

Do you have any relatives of friends currently working for Kozo? If yes, state their relationship to you and which location:

Do you have reliable transportation to and from work? YesNo

Do you have physical, mental, or medical impairment that would interfere with your ability to perform the essential duties of this job with or without an accommodation? YesNo

If "Yes", please describe in full. (Refer to position description if necessary)

Are you able at the time of employment to submit verification of your legal right to work in the U.S.? YesNo (verification and completion of Form I-9 must be submitted no later than 3 business days after date of hire)

List all present and past employment below, beginning with most recent

Company Name, Address & Phone#

Start and End Date:

Position Held:

Starting Salary:

Ending Salary:

Reason for leaving:

Name of Supervisor:

Company Name, Address & Phone#

Start and End Date:

Position Held:

Starting Salary:

Ending Salary:

Reason for leaving:

Name of Supervisor:

Company Name, Address & Phone#

Start and End Date:

Position Held:

Starting Salary:

Ending Salary:

Reason for leaving:

Name of Supervisor:

Personal References (Not former employees or relatives)

Name & Address 1:

Occupation 1:

Phone Number 1:

Name & Address 2:

Occupation 2:

Phone Number 2:

Name & Address 3:

Occupation 3:

Phone Number 3:

Record of Education

High School Name & Address:

Course of Study:

Years Attended:

Did you graduate? yesno

List Diploma or Degree:

Extracurricular Activities:

College Name & Address:

Course of Study:

Years Attended:

Did you graduate? yesno

List Diploma or Degree:

Extracurricular Activities:

Other Name & Address:

Course of Study:

Years Attended:

Did you graduate? yesno

List Diploma or Degree:

Extracurricular Activities:

Background

Are you at least 18 years of age or older? yesno

Have you ever been counseled or disciplined in a prior job for cash handling violations? yesno

Have you ever been counseled, disciplined or terminated in a prior job for theft, violence, discrimination or harasssment? yesno

If you have answered Yes to any of the above, please describe in full:

Security Data

Within the past 10 years, have you ever been convicted of a felony, entered a plea of nolo to a felony charge or been convicted of a misdemeanor? yesno

If you have answered Yes, please describe in full

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