Mitsuwa Application Form

Currently Mitsuwa has the workplace policies related to COVID-19 complying with the guidelines and requirements from the federal and/or state administration, CDC (Centers for Disease Control), as well as local health authorities, all employees are required to follow those policies and regulations which includes:

・Maintain at least six feet distance from customers and from other employees.
・Cover the nose and mouth with the face covering at all times during the workday.
・Wash your hands frequently with warm, soapy water for at least 20 seconds.
Can you perform in accordance with the above policies?*

YesNo

Can you submit the covid-19 vaccination proof/document upon hire?*

YesNo

Due to operation necessities, weekends(both Saturday and Sunday) and holidays availability are required. Are you able to work on weekends and holidays?*

YesNo

We handle/sell alcoholic beverages. Are you aged 18 or older?*

YesNo

Date of Application*

MonthDayYear
Date

Name*

PrefixFirst NameMiddle NameLast Name

Address*

Position apply for*

Cashier/Grocery ClerkMeat/Fish ClerkDeli ClerkProduce ClerkMorning PrepEarly Morning StockerWeekend Cashier Customer Service

Phone Number*

Do you consent to receive text message from Mitsuwa Marketplace?*

YESNO

Email*
example@example.com

Have you ever been employed here before?*

YesNo

Position (Last employment)*

Date from (Last employment)*

YearMonthDay
Date

Date to (Last employment)*

YearMonthDay
Date

Are you legally eligible for employment in this country?*

YesNo

Date available for work*

YearMonthDay
Date

Type of employment desired*

Full TimePart TimeTemporary/Seasonal

What is your desired salary range?*
Ex: $_._ to $_._ per Hour, $_._ to $_._ per Month

Working Schedule*

Open (Any Time / Any Day)Other

Days/hours available to work*

Do your relatives work in our company?*

YesNo

How were you referred to us for employment?*

Mitsuwa WebsiteStore PosterAdvertisementFriendCurrent EmployeeSchool Career Site

Name of Referrer*

PrefixFirst NameMiddle NameLast Name

Why are you interested in working for us?*

0/300

Employment History

Starting with your most recent employer, provide the following questions

Do you have Work Experience?*

YesNo

Employer Name 1*
Company Name if it's applicable

Employer Phone Number 1*

Employer Address 1*

Date of Employed From 1*

YearMonthDay
Date

Currently Working 1*

YesNo

Date of Employed To 1*

YearMonthDay
Date

Employment Category 1*

Full TimePart TimeTemporary/Seasonal

Working Schedule 1*

FlexibleOther

Scheduled hours worked 1*

Your Last Job Title 1*
Ex: Cashier

Name of Last Supervisor 1*

PrefixFirst NameMiddle NameLast Name

Job duties performed 1*

Why did you apply for Employer? 1*

Reason for leaving 1*

May we contact reference? 1*

YesNo

No other work history? 1*

YesNo

Employer History 2

Employer Name 2*
Company Name if it's applicable

Employer Phone Number 2*

Employer Address 2*

Date of Employed From 2*

YearMonthDay
Date

Currently working 2*

YesNo

Date of Employed To 2*

YearMonthDay
Date

Employed Category 2*

Full TimePart TimeTemporary/Seasonal

Working Schedule 2*

FlexibleOther

Scheduled hours worked 2*

Your Last Job Title 2*

Name of Last Supervisor 2*

PrefixFirst NameMiddle NameLast Name

Job duties performed 2*

Why did you apply for Employer? 2*

Reason for leaving 2*

May we contact for reference? 2*

YesNo

Educational Background - High School

Starting with your high school attended, provide the following information

High School Name*

School Address*

Select highest grade completed

9101112GED

Are you still attending?*

YesNo

No other educational background*

YesNo

Educational Background

College / Technical or Trade school/or Other Education / Training

School Name*

School Address*

Date Attended From*

YearMonthDay
Date

Currently attending*

YesNo

Date Attended To*

YearMonthDay
Date

Major*

Did you Graduate?*

YesNo

What is your degree obtained?*

DiplomaCertificationDegreeOther

Please explain "Other" in brief*

GPA*

Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying.

If you have any other work experiences/educational background, and if you are interested in another position, please state below:*

References

List name and telephone number of two business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Name - Reference 1*

PrefixFirst NameMiddle NameLast Name

Phone Number - Reference 1*

Relationship to you - Reference 1*

Number of Years Known - Reference 1*

Name - Reference 2*

PrefixFirst NameMiddle NameLast Name

Phone Number - Reference 2*

Relationship to you - Reference 2*

Number of Years Known - Reference 2*

Applicant Statement

Did you complete this application yourself?*

YesNo

If not, who did?*

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant*

Clear

Date*

YearMonthDay
Date

Thank you for taking the time to apply for the position.
We regret to inform you that Mitsuwa Marketplace will not be pursuing your candidacy for this time.

We appreciate that you are interested in our company.
Again thank you for applying.

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Employment History

Employer History 2

Educational Background - High School

Educational Background

Skills and Qualifications

References

Applicant Statement