Hanahauoli School
1922 Makiki Street
Honolulu, Hawaii 96822

Phone: (808) 949-6461 Fax: (808) 941-2216

APPLICATION FOR EMPLOYMENTINSTRUCTIONS: Please complete all portions of this employment application to be considered for employment.
If you require accommodation during the employment application process, including assistance in thecompletion of this employment application, please let us know. We are an equal opportunity employer. We do
not discriminate on the basis of age, race, sex, religion, color, national origin, ancestry, marital status, disability,sexual orientation, arrest and court record or any other protected category recognized by state and federal laws.
This employment application is valid for a three-month period after submission to the School and only for thedesired position.

PERSONAL INFORMATIONNAME (LAST NAME FIRST)PRESENT ADDRESS

APT. NO.

DO YOU MEET THE MINIMUM AGE REQUIREMENT SETBY LAW FOR THE DESIRED POSITION?

 YESPHONE NOCITYSTATECAN YOU, AFTER EMPLOYMENT, SUBMIT VERIFICATION OF YOURLEGAL RIGHT TO WORK IN THE UNITED STATES?

 YES
 NO

[NOTE: If offered employment you will be requiredto submit documentation required by IRCA.]DESIRED EMPLOYMENTDESIRED POSITIONARE YOU EMPLOYED NOW?

ZIPDATE YOU CAN STARTHAVE YOU BEEN PROVIDED WITH THE JOB DESCRIPTION OF THE DESIRED POSITION?

 YES  NO

 YES  NO

HAVE YOU EVER APPLIED FOR EMPLOYMENT AT
THIS SCHOOL BEFORE?

WHERE?

WHEN?

HAVE YOU EVER WORKED FOR THIS SCHOOLBEFORE?

WHERE?

WHEN?

 YES  NO
 YES  NO

WHO REFERRED YOU TO THIS SCHOOL?

 RELATIVE STATE EMPLOYMENT OFFICE EMPLOYMENT AGENCY  NEWSPAPER ADVERTISEMENT  FRIEND
 COLLEGE PLACEMENT SERVICE WALK IN OTHERAPART FROM RELIGIOUS OBSERVANCES, WILL YOU BE ABLE TO WORK ALL OTHER TIMES?  YES
 NO*NOTE: If hired, you will be required to perform work as required by the School.

EDUCATIONSCHOOL LEVELNAME AND LOCATION OF SCHOOLNO. OF YEARSATTENDED

DID YOUGRADUATE?

SUBJECTS STUDIEDHIGH SCHOOLCOLLEGEOTHER1FORMER EMPLOYERSLIST BELOW YOUR LAST FOUR EMPLOYERS, STARTING WITH THE MOST RECENT ONE FIRST.
FOR EACH EMPLOYER, YOU MUST ANSWER ALL QUESTIONS. USE ADDITIONAL PAPER IF NECESSARY.

NAME OF PRESENTOR LAST EMPLOYERADDRESSCITYSTARTING DATESTATEDATE LAST WORKED

NAME OF SUPERVISORZIP CODEJOB TITLETITLEMAY WE CONTACT YESYOUR SUPERVISOR?

 NO

EMPLOYER’S PHONE NUMBERDESCRIPTION OF WORKREASON(S) FOR LEAVINGNAME OF PRESENTOR LAST EMPLOYERADDRESSCITYSTARTING DATESTATEDATE LAST WORKED

NAME OF SUPERVISORZIP CODEJOB TITLETITLEMAY WE CONTACT YESYOUR SUPERVISOR?
DESCRIPTION OF WORK NOEMPLOYER’S PHONE NUMBER

REASON(S) FOR LEAVING

NAME OF PRESENTOR LAST EMPLOYERADDRESSCITYSTARTING DATESTATEDATE LAST WORKED

NAME OF SUPERVISORTITLEZIP CODEJOB TITLE

MAY WE CONTACT YES

YOUR SUPERVISOR?
DESCRIPTION OF WORK NOEMPLOYER’S PHONE NUMBER

REASON(S) FOR LEAVINGREFERENCES

GIVE THE NAMES OF THREE PERSONS YOU ARE NOT RELATED TO,WHOM YOU HAVE KNOWN AT LEAST ONE YEAR AND WHOM WE CAN CONTACT.
NAMEADDRESSYEARSKNOWNPHONENUMBER1232JOB SKILLS, QUALIFICATIONS AND EMPLOYMENT GAPSSUMMARIZE YOUR JOB SKILLS, TRAINING AND/OR STUDY THAT ARE RELEVANT FOR THE DESIRED POSITION.
ALSO, EXPLAIN ANY PERIODS THAT YOU WERE NOT WORKING. USE ADDITIONAL PAPER IF NECESSARY.

CERTIFICATION

PLEASE READ CAREFULLY BEFORE SIGNINGA.

I certify that the information contained in this application is true and correct. I understand that any false ormisleading statements or omissions regarding this application, whenever discovered, are grounds fordisqualification from further consideration or for dismissal from employment.

B.

If employed, I agree to conform to the guidelines and policies of the School. I understand that MY
EMPLOYMENT IS AT-WILL AND CAN BE TERMINATED AT ANY TIME AND FOR ANY REASON WITH
OR WITHOUT ADVANCE NOTICE.

C.

I understand and agree that only the Head of School and Director of Operations has any authority to enter
into any agreement to employ me for any specified period of time or to modify terms and conditions of myemployment. I agree that such an agreement must be in writing and signed by the Head of School or
Director of Operations, and I will not rely upon anything else.

D.

I understand and agree that the School may make a full and complete investigation of my personal oremployment history, and authorize any former employer, person, firm, corporation, school, government
agency, or other entity to provide the School with any information (including fact or opinion) they may haveregarding me. In consideration of the School’s review of this application, I release the School and all
providers of any information from any liability which may arise as a result of furnishing and receiving thisinformation, with the exception of any liability arising from a violation of the Fair Credit Reporting Act(“FCRA”). I understand and agree that if offered employment by the School, any such employment offer
shall be dependent upon the receipt of satisfactory references as determined by the School. If employedby the School, I further authorize the School to provide truthful information (including fact or opinion)
regarding my employment to any potential or future employer and release and waive any claims against
the School for truthfully communicating any such information to a potential or future employer.

E.

I understand and agree that I may be required to submit to drug testing and a complete post-offer medical
examination as part of my application for employment. I also understand and agree that I may be required tosubmit to a complete medical examination during my employment with the School, provided that suchexamination is job-related and consistent with business necessity. The cost of such examination will be paidby the School. I authorize the physician conducting the examination and any laboratory testing any specimen
obtained by the physician or collection site to disclose the results of the examination and the laboratory test to3

the School in accordance with state and/or federal laws. The School will keep such results confidential anddisclose the results only to persons who need to know or where required by law. Also, I agree to fully
cooperate and provide the School with any additional consent(s) and/or release(s) as required by the School
to investigate my employment application.
F.

The School shall inquire into and consider any criminal conviction record to determine whether you aresuited to work in close proximity with young children.

G.

I understand and agree that all of the foregoing terms and conditions will become part of my employment
relationship with the School if I am employed by the School.

Authorization/Signature of applicant:______________________________________________________ Date: _____________________________
Signature4