DFS Employment Application by Cponder11

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									                                                                                                                               APPLICATION FOR
                                                                                                                                  EMPLOYMENT

             To Applicant: We appreciate your interest in our organization and are interested in your qualifications. A clear understanding
             of your background and work history will aid us in placing you in the position that best meets your qualifications. We are an
             Equal Opportunity Employer. Consideration for employment is based solely on individual qualifications, without regard
             to age, race, religion, color, ancestry, national origin, disability, sex, marital status, sexual orientation, veteran status, or
             arrest and court record as required by applicable state and federal equal employment opportunity laws.
          (PLEASE PRINT ALL INFORMATION)

          Name                                                                                                          Soc. Sec. #                   -         -
                     Last                                    First                                Middle Initial

P                                                                                                                       Home Tel. #
          Address
E                                                  Street                                    Apt. #                     Cellular Tel. #
R
                                                                                                                        Email:
S                                 City                                State                  Zip Code
O
N         Can you, after employment, submit verification of your legal right to work in the United States?
A                Yes                No
L         Have you previously applied for a job with DFS Hawaii?                           Yes            Please give date(s)                                            No
          Were you previously employed by DFS Hawaii?                                      Yes            Date(s) From:                        to                        No
          List any relatives working for DFS Hawaii:                                                                    Relationship:



          Position(s) applied for:                      (1st choice)                                                         (2nd choice)
          Locations where you can work: (1st choice)                                                                         (2nd choice)
P         Shift(s) preferred:            (Check all that apply)                Day           Evening                  Overnight             Any Shift
O         Would you work: (Check all that apply)                              Full-Time               Part-Time               Temporary              Casual
S
               Indicate all hours available:
I
              Sunday                     Monday                Tuesday                    Wednesday                 Thursday                Friday            Saturday
T
                    to                        to                      to                     to                         to                     to                   to
I
O
          Salary/Wage desired:            $                     per                          When can you begin work?
N
          How did you hear about the position?
                   Newspaper         (which paper?                                                )       Employee            (name                                           )
                   Website      (which site?                                                 )        Walk-in           Agency         (name                                  )

                   School       (name                                                        )        Other        (please specify):                                          )

          If you are currently employed, why do you wish to resign?

O         Have you ever been discharged, requested to resign from employment, or resigned after you were told that you would
T            otherwise be terminated from employment?                                                 Yes                              No
H            If yes, please briefly state reason for the action:
E         Please list periods of unemployment over 90 days.
R
             Period:                                                                                   Reason:
          For reference purposes, have you ever worked or attended school under another name?
               Yes          Please indicate all names:                                                                                 No

Revised 03/19/09
                  List ALL employment within the last 10 years, beginning with your most recent.
                                If space is available below, list any relevant work prior to 10 years ago.
                                                         (Attach additional sheets, if necessary)


    Name of Company                           FROM               TO                     SUMMARIZE THE   REASON FOR   MAY WE CONTACT

                                            MO.    YR.     MO.        YR.               WORK YOU DID     LEAVING     THIS EMPLOYER

    City, State

                                                                            Position:                                Yes
    Phone No.                               STARTING          LAST          Duties:
                                             SALARY          SALARY                                                  No
    Name of Supervisor

                                                                                                                     Check with
                                                                                                                     me first
    Status          Full-time   Part-time     On-Call


    Name of Company                           FROM               TO                     SUMMARIZE THE   REASON FOR   MAY WE CONTACT
E                                           MO.    YR.     MO.        YR.               WORK YOU DID     LEAVING     THIS EMPLOYER

M   City, State

P                                                                           Position:                                Yes
L   Phone No.                               STARTING          LAST          Duties:
                                             SALARY          SALARY                                                  No
O
    Name of Supervisor
Y
                                                                                                                     Check with
M                                                                                                                    me first
E
    Status          Full-time   Part-time     On-Call
N
T   Name of Company                           FROM               TO                     SUMMARIZE THE   REASON FOR   MAY WE CONTACT

                                            MO.    YR.     MO.        YR.               WORK YOU DID     LEAVING     THIS EMPLOYER

    City, State
H                                                                           Position:                                Yes
I   Phone No.                               STARTING          LAST          Duties:
S                                            SALARY          SALARY                                                  No
T   Name of Supervisor

O                                                                                                                    Check with
R                                                                                                                    me first

Y   Status          Full-time   Part-time     On-Call


    Name of Company                           FROM               TO                     SUMMARIZE THE   REASON FOR   MAY WE CONTACT

                                            MO.    YR.     MO.        YR.               WORK YOU DID     LEAVING     THIS EMPLOYER

    City, State

                                                                            Position:                                Yes
    Phone No.                               STARTING          LAST          Duties:
                                             SALARY          SALARY                                                  No
    Name of Supervisor

                                                                                                                     Check with
                                                                                                                     me first
    Status          Full-time   Part-time     On-Call


    Name of Company                           FROM               TO                     SUMMARIZE THE   REASON FOR   MAY WE CONTACT

                                            MO.    YR.     MO.        YR.               WORK YOU DID     LEAVING     THIS EMPLOYER

    City, State

                                                                            Position:                                Yes
    Phone No.                               STARTING          LAST          Duties:
                                             SALARY          SALARY                                                  No
    Name of Supervisor

                                                                                                                     Check with
                                                                                                                     me first
    Status          Full-time   Part-time     On-Call
    (Please check off any of the following in which you are experienced or trained.)

         Typing            WPM                                 10-Key Calculator         Touch                       Sight
         Cash Register or Point of Sales System                Personal Computer                       Interactive Computer Systems
S
K          Software (Please specify)
I    If you are applying for a position that requires you to drive, do you have a valid Driver's License?
L
           Yes       (Type:                           )            No
L
S    Language skills are very helpful in our business. Please indicate if you can speak or read in a language other than English.

     Japanese:                Read         Write      Speak      Level of Fluency:               Basic              Conversational       Fluent

     Korean:                  Read         Write      Speak      Level of Fluency:               Basic              Conversational       Fluent

     Mandarin:                Read         Write      Speak      Level of Fluency:               Basic              Conversational       Fluent

     Other:
                              Read         Write      Speak      Level of Fluency:               Basic              Conversational       Fluent

                              Read         Write      Speak      Level of Fluency:               Basic              Conversational       Fluent

    Please indicate any special training, skills or awards you may have received which you would like us to consider as part of your
       application for employment.




       SCHOOL                       NAME &                       MAJOR OR            YEARS COMPLETED                   DID YOU       DIPLOMA
                                CITY, STATE                   COURSE OF STUDY                                         GRADUATE?      OR DEGREE



                                                                                     less than


        HIGH                                                                             1       1     2    3   4      Yes
E
D                                                                                                (circle one)

U                          Presently enrolled?                                                                         No
C                             Yes                No
A
T                                                                                    less than
I
                                                                                         1       1     2    3   4      Yes
O
      COLLEGE                                                                                    (circle one)
N
                           Presently enrolled?                                                                         No
                              Yes                No


                                                                                     less than


     OTHER                                                                               1       1     2    3   4      Yes
                                                                                                 (circle one)
                           Presently enrolled?                                                                         No
                             Yes               No



R
    Please list three references that are familiar with your work ability.
E
F
                        NAME                                      OCCUPATION AND PLACE OF BUSINESS                                PHONE NUMBER
E
R
E
N
C
E
S
    Please read carefully, initial each paragraph where indicated, and sign below:
    Note: A copy of this certification is available upon request in Japanese, Mandarin, and Korean.

            1.   DFS is committed to providing our employees with a safe and healthy working environment, free of the problems associated with illegal
    (initials)   substance abuse. Because of this, employment is contingent upon successful completion of a drug screening test.

                 a.   I understand and agree to undergo a pre-employment drug test in accordance with the DFS Substance Abuse Policy. Unless otherwise
                      advised, I understand that such testing may include testing for amphetamines, cannabinoids (this includes marijuana and hemp in
                      any form -- hemp oil, hemp beer, hemp salad dressing, etc. -- and any other marijuana derivatives. This means that consumption of hemp
                      is NOT an excuse for testing positive for controlled substances), cocaine, opiates and phencyclindine, and other substances allowable
                      under the law. I understand that failure to undertake such a test will constitute a withdrawal of my application for employment.

                 b.   I further understand that, should I be hired, I may be required, and by initialing this paragraph, agree to submit to drug and/or alcohol
                      tests during the course of my employment in accordance with the DFS Substance Abuse Policy.

                 c.   In addition, I understand that a positive result on a test may be grounds for rejection of my application for employment or, if hired,
                      disciplinary action, up to and including termination.

                 d.   I understand and agree that it is my responsibility to familiarize myself with the terms of the DFS Substance Abuse Policy and how it applies
                      to me. I further agree to comply with the terms and requirements of the DFS Policy as set forth therein.
C                e.   Based on the foregoing disclosures, I hereby state my willingness to undergo a drug or alcohol screening examination and authorize the
E                     release of my drug or alcohol test results to management of the Company and its physicians.
R
T           2.   I consent to and authorize the Company to make a full and complete investigation of my education and/or employment history and personal
I   (initials)   references. In consideration of the Company's review of this application, I release the Company and all providers of any information from
F                any liability as a result of furnishing and receiving this information.
I
            3.   I understand that if I am applying for a position that involves the sale of liquor, I may be required to provide proof of age, in accordance with
C
    (initials)   Chapter 281-78 of Hawaii Revised Statutes.
A
T           4.   This application is not a contract and cannot create a contract. I understand that this is only an application for employment, and does not
I   (initials)   constitute a promise or guarantee that an offer of employment is or will be offered to me. I further understand that no contract of employment
O                is created or intended by any statement made in conjunction with any interview or any other oral statements. The only way an employment
N                contract can exist is by written document, entitled, "DFS Employment Contract," that has been signed by the Managing Director of DFS.

            5.   I understand that if my employment is not subject to a written contract signed by the Managing Director of DFS and myself (in which
    (initials)   case it is governed by the terms of that written contract), my employment is "at will" and can be terminated at any time, either by
                 myself or DFS Hawaii, for any or no reason, and with or without prior notice.

            6.   I understand that if I receive a conditional offer of employment, the Company may inquire into and consider my criminal conviction record.
    (initials)   The Company may withdraw its conditional offer of employment if the Company determines that my criminal conviction record bears a rational
                 relationship to the job for which I am applying. Convictions that are more than ten (10) years old will not be considered.

            7.   I certify that the information contained in this application or additional attachments are true, correct and complete to the best of my knowledge,
    (initials)   and understand that any false or misleading statements or omissions, whenever discovered, regarding this application are grounds for
                 disqualification from further consideration or for dismissal from employment.




                        Signature of Applicant                                                                    Date of Application




          Mailing Address:               DFS Hawaii                                        Email Address: hawaii.careers@dfs.com
                                         Attn: Talent Management                           Website: www.dfsgalleria.com/jobs
                                         P.O. Box 29500                                    Phone No.: (808) 837-3439
                                         Honolulu, HI 96820                                Fax No.: (808) 837-3490
               EQUAL EMPLOYMENT OPPORTUNITY FORM


This information is being requested in accordance with federal regulations. The
information is voluntary and will not be used when considering you for employment with
our company.


     Full Name:                                           Date:
                    (LAST, FIRST)




               Racial or Ethnic Group:

                              Hispanic or Latino

                              White or Caucasian

                              Black or African American

                              Native Hawaiian or Other Pacific Islander

                              Asian

                              American Indian or Alaska Native

                              Two or More Races


               Gender:                 Male          Female

               Position applied for:



                             Please return completed form to:

                                           DFS Hawaii
                                    Attn: Talent Management
                                         P.O. Box 29500
                                       Honolulu, HI 96820



                                                                                  3/24/09
                          NOTICE TO APPLICANT / EMPLOYEE

                                            and

              AUTHORIZATION TO OBTAIN CONSUMER REPORT



Notice regarding Consumer Reports

This notice is to inform you that DFS may obtain a consumer report or reports in
connection with your application for employment with DFS. “Consumer reports” include,
but are not limited to, credit reports, criminal background checks and Department of
Motor Vehicle records.

Authorization to Obtain Consumer Report

By signing below, I certify that I have received a copy of DFS’s written notification that it
may obtain a consumer report or reports on me, and I authorize DFS to obtain such a
report or reports for use in connection with my application for employment.

I understand that the term “consumer report” includes, but is not limited to, credit
checks, criminal background checks, and Department of Motor Vehicle records.


_______________________
Signature of Applicant/Employee

_______________________
Print Name

_______________________
Date



*This document is to be signed in duplicate originals. One original is to be provided to
the applicant/employee and the other is to be retained by DFS.



                                  EMPLOYER COPY


                                                                                 Revised 3/30/09
                          NOTICE TO APPLICANT / EMPLOYEE

                                            and

              AUTHORIZATION TO OBTAIN CONSUMER REPORT



Notice regarding Consumer Reports

This notice is to inform you that DFS may obtain a consumer report or reports in
connection with your application for employment with DFS. “Consumer reports” include,
but are not limited to, credit reports, criminal background checks and Department of
Motor Vehicle records.

Authorization to Obtain Consumer Report

By signing below, I certify that I have received a copy of DFS’s written notification that it
may obtain a consumer report or reports on me, and I authorize DFS to obtain such a
report or reports for use in connection with my application for employment.

I understand that the term “consumer report” includes, but is not limited to, credit
checks, criminal background checks, and Department of Motor Vehicle records.


_______________________
Signature of Applicant/Employee

_______________________
Print Name

_______________________
Date



*This document is to be signed in duplicate originals. One original is to be provided to
the applicant/employee and the other is to be retained by DFS.



                                  APPLICANT COPY


                                                                                 Revised 3/30/09

								
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