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                            侍 SAMURAI     JAPANESE CUISINE SUSHI BAR & GRILL

                                 NEW EMPLOYEE APPLICATION
       WHEN YOU COMPLETE THIS APPLICATION YOU MUST TO RETURN IT TO OUR MANAGER FOR YOUR FIRST INTERVIEW

                                              FOR MANAGER'S INTERVIEW USE:



                                     EXPLAIN YOUR PERSONAILITY.RATE FROM 1 TO 10
  FLEXIBLE                HONEST                   FRIENDLY                   DEPENDABLE            EVEN-TEMPER
    LATE                 AMBITIOUS                 ADAPTABLE                   MOTIVATED             ATTITUDE
   ALERT

APPLICATION DATE:                                               EMPLOYEE DATE:
FIRST NAME:                                       MI                          LAST NAME:
S.S.N:
ARE YOU OVER 18 YEARS OF AGE ?       口 YES        口 NO          DATE OF BIRTHDAY:                            AGE:
SEX:          口 MALE    口 FEMALE
CURRENT ADDRESS:
CITY:                                STATE:                                   ZIP:
HOME PHONE:                                                     CELL PHONE:
HOW LONG HAVE YOU BEEN A RESIDENT AT CURRENT ADDRESS ?                                     YEARS:
PRIOR ADDRESS:
CITY:                                STATE:                                   ZIP:

HOW LONG DID YOU RESIDE AT PRIOR ADDRESS ?                      YEARS:
HAVE YOU APPLIED OR WORKED FOR SAMURAI IN THE PAST ?                          口 YES        口 NO
IF SO, EXPLAIN WHY YOU'RE RE-APPLYING:


NAME FRIENDS OR RELATIVES WHO IS CURRENTLY WORKING FOR SAMURAI:

HOW LONG YOU THINK YOU WILL WORK FOR THIS COMPANY ?                           MONTH:                YEARS:

EMERGENCY CONTACT INFORMATION
NAME:                                                                         HOME PHONE:
ADDRESS:                                                                      WORK PHONE:
CITY:                   STATE:                    ZIP:                        CELL   PHONE:
HOW IS THIS PERSON RELATED TO YOU ?

POSITION DESIRE
POSITION:                                         DATE YOU CAN START WORK:
HAVE YOU WORKED AT A JAPANESE RESTAURANT BEFORE OR EXPERIENCED AT A DINE-IN RESTAURANT?
口 YES         口 NO          IF SO, HOW LONG:
ARE YOU CURRENTLY EMPLOYED ?              口 YES          口 NO
IF SO, MAY WE CONTACT YOUR CURRENT EMPLOYER ?                   口 YES         口 NO
ARE YOU A STUDENT?         口 YES     口 NO
      IF SO,WHAT'S YOUR SCHOOL SCHEDULE?
EMPLOYMENT HISTORY AND EDUCATIONAL BACKGROUND
LIST YOUR PAST THREE(3) EMPLOYERS, BEGINNING WITH THE MOST RECENT:
1st COMPANY NAME                              ADDRESS                                 PHONE             SUPERVISOR


       HOW LONG         EXPLAIN WHY YOU LEFT:




2nd COMPANY NAME                              ADDRESS                                 PHONE             SUPERVISOR




                                      a65bed61-3e45-49b6-8338-ac91e4a56e2d.xlsx                                      Page 1
    HOW LONG                 EXPLAIN WHY YOU LEFT:


3rd COMPANY NAME                                ADDRESS                                    PHONE               SUPERVISOR


    HOW LONG                 EXPLAIN WHY YOU LEFT:


LIST THE PAST THREE (3) SCHOOLS YOU'VE ATTENDED, BEGINNING WITH THE MOST RECENT:
NAME AND ADDRESS                   YEARS COMPLETED                            DID YOU GRADUATE ?             MAJOR/DEGREE
1
2
3
GENERAL
LIST ANY FOREIGN LANGUAGES YOU SPEAK AND CHECK YOUR LEVEL OF FLUENCY:
                              MINIMAL                      FLUENT                      READ                   WRITE
                              MINIMAL                      FLUENT                      READ                   WRITE
                              MINIMAL                      FLUENT                      READ                   WRITE

LIST ANY SPECIAL SKILLS / ABILITIES YOU HAVE THAT CAN BE APPLIED TO THIS POSITION:




SECURITY
HAVE YOU EVER BEEN BONDED ?                    口 YES           口 NO
           IF SO, EXPLAIN:




HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE PAST 5 YEARS ?                                  口 YES        口 NO
IF SO, EXPLAIN ( THIS WILL NOT NECESSARILY EXCLUDE YOU FROM CONSIDERATION):




MILITARY
HAVE YOU SERVED IN THE MILITARY ?                      口 YES           口 NO          BRANCH:
SERVED FROM           /        /          TO           /           /                                RANK:
DO YOU HAVE ANY MILITARY COMMITMENT, INCLUDING NATIONAL GUARD SERVICE THAT WOULD
INFLUENCE YOUR WORK SCHEDULE ?                             口 YES         口 NO
        IF SO, EXPLAIN:
ARE YOU A VIETNAM VETERAN ?                    口 YES       口 NO        ARE YOU A DISABLED VETERAN ?           口 YES
ARE YOU A SPECIAL DISABLDED VETERAN ?                        口 YES            口 NO
REASONABLE ACCOMMODATIONS: IN THE EVENT YOU BELIEVE YOU WILL NEED REASONABLE
ACCOMMODATIONS TO ASSIST YOU IN PERFORMING YOUR JOB, PLEASE CONTACT YOUR SUPERVISOR
OR HUMAN RESOURCES COORDINATOR .

AUTHORIZATION
I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST
OF MY KNOWLEDGE AND UNDERSTAND THAT IF EMPLOYED, FALSIFIED STATEMENT ON THIS
APPLICATION WILL BE GROUNDS FOR DISMISSAL.




                                                                                     APPLYER'S SIGNATURE:



                                                                                           DATE:




                                         a65bed61-3e45-49b6-8338-ac91e4a56e2d.xlsx                                          Page 2
N
R FOR YOUR FIRST INTERVIEW




        EVEN-TEMPER




            SUPERVISOR




            SUPERVISOR




                             a65bed61-3e45-49b6-8338-ac91e4a56e2d.xlsx   Page 3
 SUPERVISOR




MAJOR/DEGREE




        口 NO




               a65bed61-3e45-49b6-8338-ac91e4a56e2d.xlsx   Page 4

				
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posted:4/3/2013
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