Uwajimaya On-line Job Application Form


First Name:    MI:    Last Name:  
Address:
City: State:   Zip:  
Home Phone:   
Alternate (Cell) Phone:   
Email Address:
Position:
Store Location:

Have you ever been employed by Uwajimaya, Inc?   Yes No
If Yes, When:    (ie: 01/01/2001)  

Where:  

Are you legally eligible to work in the United States?  (proof of right to work in the US will be required if hired)
  Yes No

Salary expectations?       

How were you referred to us?       

Please list other trainings, skills or certifications held       

Date available to work:   (ie: 01/01/2001)    

Are you 18 years of age or older?     Yes No


Education Name and Location of School:  Years Completed:  Degree Received: 
Grade/Jr. High School:  
High School or GED:  
College:  
Graduate School:  
Trade, Business
or Vocational School:  


Language Skills:

Languages:   read:   write:   speak:  
Languages:   read:   write:   speak:  
Languages:   read:   write:   speak:  


Hours Available to Work:
Sunday:   Start:   End:  
Monday:   Start:   End:  
Tuesday:   Start:   End:  
Wednesday:   Start:   End:  
Thursday:   Start:   End:  
Friday:   Start:   End:  
Saturday:   Start:   End:  


Equal Opportunity Employer
Beginning with current/most recent employer or status, list in DATE ORDER all periods of employment and voluntary work. If employed, may we contact your employer?
  Yes No

Employer
Business:     Phone:    
Address:     City:     State:  
Job Title: 
Duties: 
Supervisor:     Title:   Phone:    
Wage/Salary: 
Dates worked from:    (ie: 01/02/2000) To:    (ie: 01/02/2000)
Reason for leaving:  



Employer
Business:     Phone:    
Address:     City:     State:  
Job Title: 
Duties: 
Supervisor:     Title:   Phone:    
Wage/Salary: 
Dates worked from:   (ie: 01/02/2000)   To:    (ie: 01/02/2000)
Reason for leaving:  



Employer
Business:     Phone:    
Address:     City:     State:  
Job Title: 
Duties: 
Supervisor:     Title:   Phone:    
Wage/Salary: 
Dates worked from:    (ie: 01/02/2000)   To:    (ie: 01/02/2000)
Reason for leaving:  



Employer
Business:     Phone:    
Address:     City:     State:  
Job Title: 
Duties: 
Supervisor:     Title:   Phone:    
Wage/Salary: 
Dates worked from:    (ie: 01/02/2000)   To:    (ie: 01/02/2000)
Reason for leaving:  

Application Information Release

Please read carefully and check the appropriate box, or your application will not be processed. I hereby certify that this application was completed by me and all information provided is true and accurate to the best of my knowledge. I authorize Uwajimaya, Inc. to investigate all statements contained in this application and to request information about me from previous employers and educational institutions. I expressly authorize my previous employers to provide information and opinions concerning my work and work habits. I also release all parties and persons connected with any requests for information from all claims, liabilities and damages for whatever reason, arising out of furnishing any information that may be sought in arriving at an employment decision. I understand that false or misleading information in this application may be cause for denial of employment or for dismissal, if employed.

I understand that employment at Uwajimaya, Inc. is on an "At-Will" basis. That is, if employed by Uwajimaya, Inc., employment is for no definite period and may be terminated, at any time, with or without notice, by either party.

I also understand that if employed, I must comply with all current and subsequently issued company policies including the drug-free policy in accordance with the US Department of Transportation.

By checking this box, I declare that I understand and agree with the above Application Information Release.

Name of Applicant: 


To All Applicants,

 Federal law requires that Uwajimaya, Inc. maintain an Affirmative Action Program. In accordance, we request that you complete this form. This information will be kept CONFIDENTIAL and will in no manner affect your employment with us.
Completion of this form is strictly voluntary.

Ethnic Origin:
  Hispanic or Latino 
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

  White (Not Hispanic or Latino) 
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

  Black or African American (Not Hispanic or Latino) 
A person having origins in any of the black racial groups of Africa.

  Native Hawaiian or Pacific Islander (Not Hispanic or Latino) 
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

  Asian (Not Hispanic or Latino) 
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent including, for example, Japan, the Philippine Islands, and Thailand.

  American Indian or Alaska Native (Not Hispanic or Latino) 
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

  Two or more races (Not Hispanic or Latino) 
All persons who identify with more than one of the above five races

  Decline to answer 

Gender:    Veteran Status:  

Do you have a disability (physical or mental impairment) which substantially limits one or more of your life's activities? Yes No



        

Uwajimaya is an Equal Opportunity Employer.