Come Work With Us Would you like to work at Shakas? Please fill out the application form below and we will get back to you as soon as possible. 1 2 3 4 Shaka’s Employee Application If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Instruction to Applicant Please answer all questions. If the answer to any question(s) is No or None, do not leave the item blank, but write No or None. The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age. First Name * Last Name * What position are you applying for? Select all that apply. CashierDeliSalt Lake ExpressClerical What hours are you available? Morning (6AM-2PM)Afternoon (10AM-6PM)Evening (2PM-10PM)Night (10PM-6AM) Birth Date * Social Security Number * Phone * Email * Current Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select an Option Zip Code Previous Addresses Previous Address 1 Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select an Option From * To * Additional Previous Address? Previous Address 2 Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select an Option From To Additional Previous Address 2 Previous Address 3 Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select an Option From To Emergency Contact * Emergency Contact Phone * Can you meet the attendance or work hour requirements of the job applied for? * Yes No Maybe Have you any relatives employed by this company? * Yes No Select an Option If yes, give names, and position Have you ever worked for this company before? * Yes No Select an Option Where? When? Are you now employed? * Yes No Select an Option If so, may we inquire of your present employer? * Yes No Select an Option Have you ever been convicted of a felony? (Such conviction is not an absolute bar to employment but will be considered in relation to specific job requirements) * Yes No Select an Option Do you drink alcohol? * Yes No Select an Option Are you currently using any illegal drugs? * Yes No Select an Option If yes, what drugs? Do you smoke? * Yes No Select an Option Are you currently using any prescription drugs? * Yes No Select an Option If yes, what drugs? Can you currently pass a drug test? Yes No Maybe Why would you be a valued employee and a good fit for the position you are applying for? * Rate yourself 1-10 on the following skills and abilities: Counting back change * Friendly with customers * Willing/available to cover shifts * Positive attitude * Clear communication skills * Self starter * Professional appearance * Highest Level of education Completed High School Highschool Name College or University College or University Name Business or Technical School Business or Technical School Name If you served in the military, list any skills learned which you feel are relevant to the position you are applying for Employment History Give a COMPLETE RECORD of all employment for the past 3 years, including any period of unemployment or self employment and all commercial driving experience for the past ten years. Employer 1 Present or Last Employer * Dates Employed: From * To * Phone * Address * City * State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select an Option Supervisor * Position Held * Salary * Reasons For Leaving * Employer 2 Previous Employer Dates Employed: From To Phone Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select an Option Supervisor Position Held Salary Reasons For Leaving Employer 3 Previous Employer Dates Employed: From To Phone Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select an Option Supervisor Position Held Salary Reasons For Leaving Employer 4 Present or Last Employer Dates Employed: From To Phone Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select an Option Supervisor Position Held Salary Reasons For Leaving Personal References List three persons, for reference, other than relatives, who have knowledge of your safety habits. Reference 1 Name * Address * Phone * Reference 2 Name * Address * Phone * Reference 3 Name * Address * Phone * Sign and Submit E-signature: By typing your name you certify that all the information given is true and correct. * How did you hear about this position? * Select an Option Radio Newspaper Internet Job Posting Friend Word of Mouth Other Referral Code (If Applicable)
