Uwajimaya On-line Job Application Form

First Name: MI: Last Name: Address: City: , State: Zip: Home Phone: (no dashes) ie: 2061231234 Alternate (Cell) Phone: (no dashes) ie: 2061231234 email Address: Position: Select Position Grocery Clerk Gift Clerk Deli Clerk Produce Clerk Courtesy Clerk Seafood Cashier Receptionist other Select Full ot Part Time Full Time Part Time Temporary Store Location: Select Store Location Seattle, Washington Bellevue, Washington Beaverton, Oregon
Have you ever been employed at Uwajimaya? yesno Are you legally entitled to work at in the United States? yesno (proof of right to work is required) Have you been convicted of a felony in the last 10 years that reasonably relates to the job you are applying for? yesno (a conviction may not necessarily eliminate you as a candidate for employment.) If yes, please indicate the date and nature of offense: Date available to work:(IE: 01/01/2001) How were you referred to us? If under 18, please state your age:
Language Skills:
Languages:	read:	Select Ability Fair Good Fluent write:	Select Ability Fair Good Fluent speak: Select Ability Fair Good Fluent
Languages:	read:	Select Ability Fair Good Fluent write:	Select Ability Fair Good Fluent speak: Select Ability Fair Good Fluent
Languages:	read:	Select Ability Fair Good Fluent write:	Select Ability Fair Good Fluent speak: Select Ability Fair Good Fluent
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? yesno Employer: Business:phone number(ie: 2061231234) Address: City:State: Duties: Supervisor: Title:phone number:(ie: 2061231234) Dates worked From:(ie: 01/02/00) To:(ie: 01/02/00)  Reason for leaving:
Employer: Business:phone number(ie: 2061231234) Address: City:State: Duties: Supervisor: Title:phone number:(ie: 2061231234) Dates worked From:(ie: 01/02/00) To:(ie: 01/02/00)  Reason for leaving:
Employer: Business:phone number(ie: 2061231234) Address: City:State: Duties: Supervisor: Title:phone number:(ie: 2061231234) Dates worked From:(ie: 01/02/00) To:(ie: 01/02/00)  Reason for leaving: Application Information Release Please read carefully and check the appropriate box, or your application will not be processed. This application was completed by me and all information provided is true and complete 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 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. Name of Applicant:Acknowledgement: yesno