Applicant Information
Last name:
First name:
Home Phone:
Cell phone:
Email address:
Birthday

Street Address:
Are you a citizen of the US? Yes No
If no, are you authorized to work in the US: Yes No
Are you related to anyone at Puka Dog? Yes No
Job Preference
Job Location Position applied for Full/part time
Poipu, Kauai Manager Full-time
Waikiki, Oahu Assistant Manager Part-time
    Sales crew    
    Maintenance    
           
Are you available for work any day and hours during the week? Yes No
  If no, list availability below:        
 
Availability
  Mon. Tues. Wed. Thurs. Fri. Sat. Sun.
From:
To:
Education
High school name: Address:
Entry date: Did you graduate?

Yes No
Exit date:    
College name:

Address:
Entry date: Did you graduate? Yes No
Exit date:
Previous Employment
Company: Phone:
Address: Supervisor:
Job Title: Start:
    End:
Responsibilities:
Reason for leaving :
May we contact your previous supervisor for a reference? Yes No
Company: Phone:
Address: Supervisor:
Job Title: Start:
    End:
Responsibilities:
Reason for leaving :
May we contact your previous supervisor for a reference? Yes No

References
Please provide two professional references.
Full name: Relationship:
Company: Phone:
Address:    
Full name: Relationship:
Company: Phone:
Address:    
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
   

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