For Don Quijote Group Office to Complete:

Don Quijote Group

Location:

APPLICATION FOR EMPLOYMENTPosition:Interview Date:

An Equal Opportunity Employer

Interviewer:

Don Qujote (USA) Co., Ltd, Marukai Hawaii Co. Ltd, or Oriental Seafood, Inc.(The Don Quijote Group) are equal opportunity employers with a policy of hiring and promoting on the basis ofqualifications, proven ability, and level of contribution without regard to race, color, creed, ethnicity, sex, gender (including gender nonconformity and status as a transgender or transsexualindividual), religion, marital status, age, national origin or ancestry, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, geneticinformation, medical condition (including cancer and genetic characteristics), sexual orientation, gender identification or any other protected class, characteristic, or consideration madeunlawful under applicable federal, state, or local laws. The Don Quijote Group will consider for employement qualified applicants with criminal histories in a manner consistent withapplicable federal, state, or local laws.

I. APPLICANT INFORMATION
Last NameFirstMiddle Initial

SSN
You will be required tosubmit a socialsecurity number if anoffer of employment ismade to you.

Present Address

StreetCity

Primary Phone Number

Other Phone Number(()

Have you ever worked under a different name? Yes
If yes, please identify any other names you have used.

No)

StateZip Code

E-Mail Address

If hired, can you provide verification of your legal right to work in the United States?

 Yes___________________________________________________

No

Are you of legal age to sell/dispense alcohol
beverages without supervision? Yes No

If less than 18 years of age, do you have or are
you able to obtain a work permit? Yes No

How did you hear about us?
 Walk-in  Internet  Employee:__________________

If required for the position, do you have a driver’s

If hired, would you have reliable transportation

List any names of individuals you know working for thislicense? Yes

to and from work?

Yes

company_________________________________________ Other: __________________________________________
 No

No

II. EMPLOYMENT INFORMATION
Position you are applying for:Wage/Salary Desired

Type of Employment Desired Full Time  Part Time  Temporary/Seasonal$
Have you ever applied for employment with the Company?
Have you ever been employed by the Company?
 Yes
 No

Date Available to Start WorkTo:
AM / PM No If so, please provide the dates and locations:If so, please provide the following_____________________________________________________________________________________
Job Title
DateLocation
Supervisor

Would you be willing to work overtime?
 Yes
 No

Days and Hours Available to Work
SundayMondayFrom:
From:
AM / PMAM / PMTo:

 Yes

 Other____________________________________

Tuesday
From:
AM / PMTo:

AM / PMAM / PMCan you work flexible hours, including weekends and major holidays?
 Yes
 No

Wednesday
From:
AM / PM

From:

ThursdayTo:

To:

FridaySaturdayFrom:
AM / PMFrom:
AM / PMTo:

AM / PMAM / PMTo:

AM / PMAM / PMAM / PMII. EDUCATION INFORMATION
Circle Last Grade
CompletedDid yougraduate?

High School1234

 Y N

College/University

1234

Y N

Other Certification/Relevant Training

1234

Y N

School Level

Name and City/State of School

Course of Study

IV. OTHER SKILLS, LICENSE & CERTIFICATIONS
Do you have any other experience, training, qualifications, or skills which you feel make you especially suited for work at the company? If so, please explain.

__________________________________________________________________________________________________________________________________________________________________________________________________________
V. LANGUAGE
Foreign Languages (indicate proficiency to speak, read and write if directly job related)1.

 Speak  Read  Write2.

 Speak  Read  Write
1

3.

 Speak  Read  Write
Updated: 1/2017

Degree orDiploma

VI. EMPLOYMENT INFORMATION (Start with Current or Most Recent Employer)
List below all present and past employment starting with your most recent employer. Complete this section and/or attach resume.

1Company Name

Phone

Manager’s Name and Title

Street Address

CityState

Position Title Start

Position Title End

From (mm/yy)

To (mm/yy)

Zip

DutiesReason for leaving:2

May we contact this current employer?

Company NamePhone Yes No
Manager’s Name and Title

Street Address

City

State

Position Title Start

Position Title EndCompany Name

Phone

Manager’s Name and Title

Street Address

CityState

Position Title Start

Position Title End

From (mm/yy)

To (mm/yy)

Zip

DutiesReason for leaving:

3

From (mm/yy)

To (mm/yy)

Zip

DutiesReason for leaving:VII. PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH AND SIGN BELOW____________
____

____
____

Truthful Application. I certify that all the information provided in this application is true and that I have not knowingly withheld any facts that might affect theCompany’s decision to employ me. I am aware that any misrepresentation or omission on this application shall be sufficient cause for rejection of this applicationor for immediate termination of employment if I am employed, regardless of the time elapsed before discovery.
Consent to Employment Verification. I hereby authorize the Don Quijote Group to thoroughly investigate my references, work record, education, and othermatters related to my suitability for employment, and further authorize the references I have listed to disclose to the Don Quijote Group any and all letters, reports,and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Don Quijote Group, myformer employers, and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of, or in any way
related to, such investigation or disclosure.
New Hire Orientation Period. I understand all new employees are on a 90-day new hire introductory period, after which suitability for regular employment will bedecided by the Company.
Employment-at-will Relationship. I understand that nothing contained in the application, or conveyed during any interview which may be granted or during myemployment, if hired, is intended to create an employment contract between me and Company. In addition, I understand and agree that if I am employed, myemployment is for no definite or determinable period and may be terminated at any time, with or without cause and with or without prior notice, at the option ofeither myself or the Company, and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed byme and the Company’s President or equivalent position.
Proof of Legal Right to Work in U.S. I understand that if I am hired, I will be required to provide proof of identity and proof that I may legally work within the U.S.
Background Checking. I understand the Don Quijote Group may perform a background check on all applicants who receive employment offers. All checks that are
performed by a third-party will be completed at the expense of the Company. I hereby certify that the entries made on this employment application are true andcorrect. I agree to submit to a post-offer pre-employment substance and/or alcohol examination.
PLEASE READ THE ABOVE STATEMENTS AND SIGN BELOW TO INDICATE YOUR AGREEMENT
Signature of Applicant: ________________________________________________

Date: ___________________________

REV: 1/2017

2

Updated: 1/2017