EMPLOYMENT APPLICATION

PLEASE PRINT OUT AND EMAIL FAX OR MAIL TO ADDRESS BELOW

EMPLOYMENT APPLICATION

Employer: Saz, Inc. T/A Tangerine ~ Kamakura ~ Coconuts
Address: 3501-11 Pacific Avenue
City/St/Zip: Wildwood, New Jersey 08260
Telephone: (609) 522-6077

Fax: 609) 522-6237
Email:TKC3501@aol.com

It is the policy of SAZ, Inc. T/A Tangerine ~ Kamakura ~ Coconuts to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

APPLICANT NAME:__________________________________________________________________
ADDRESS: ________________________________________________________________________

CITY/STATE/ZIP: ___________________________________________________________________

Number of Years at this address:________________________________________________________

DAYTIME PHONE:_______________________________ EVENING PHONE:____________________

SOCIAL SECURITY NUMBER:__________________________________________________________

WHO SHOULD BE CONTACTED IF YOU ARE INVOLVED IN AN EMERGENCY:

CONTACT NAME:____________________________________________________________________

RELATIONSHIP:_____________________________________________________________________

ADDRESS:__________________________________________________________________________

CITY/STATE/ZIP:______________________________________________________________________

DAYTIME PHONE:____________________________ EVENING PHONE:_________________________

JOB POSITION APPLIED FOR:___________________________________________________________

SALARY DESIRED:$_______________ per_____________________

REFFERAL SOURCE: WHO REFERRED YOU TO OUR COMPANY:_____________________________

HAVE YOU APPLIED WITH US BEFORE: ___________YES-------NO___________

IF YES, WHEN?_______________________________________________________

ARE YOU AT LEAST 18 YEARS OLD? ___________ YES-----NO_______________

HOW WILL YOU GET TO WORK:__________________________________________

DRIVER’S LICENSE NUMBER:_____________________________________________
WHAT STATE IS YOUR LICENSED ISSUED?:_________________________________

ARE YOU WILLING TO WORK ANY SHIFT, INCLUDING NIGHTS & WEEKENDS ______ Yes----NO____

If NO please state limitations:______________________________________________________________

IF YOU ARE OFFERED EMPLOYMENT, WHEN WOULD YOU BE AVAILABLE TO START?____________

ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE UNITED STATES _________YES----NO_____

ARE YOU ABLE TO PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB POSITION WITH OR WITHOUT REASONABLE ACCOMMODATIONS:__________ YES--------NO__________

WHAT REASONABLE ACCOMMODATIONS WOULD YOU REQUIRE:___________________________

HAVE YOU EVER BEEN CONVICTED OF A CRIME, INCLUDING TRAFFIC VIOLATIONS?

___________YES __________NO _____________ If yes, please explain:__________________

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

APPLICAANT EMPLOYMENT HISTORY: LIST YOUR CURRENT OR MOST RECENT EMPLOYMENT FIRST:

Employer Name:______________________________________________________________

Address:____________________________________________________________________

City/State/Zip:_________________________________________________________________
Job Duties:____________________________________________________________________
Reason for Leaving:____________________________________________________________

Dates of Employment (Month/Year):________________________________________________

Employer Name:______________________________________________________________

Address:____________________________________________________________________

Dates of Employment (Month/Year):________________________________________________

Employer Name:______________________________________________________________

Address:____________________________________________________________________

City/State/Zip:_________________________________________________________________

Job Duties:____________________________________________________________________

Reason for Leaving:____________________________________________________________

Dates of Employment (Month/Year):________________________________________________

APPLICANT’S EDUCATION & TRAINING: PLEASE LIST:

High School Name & Address

Last Grade: 9 --10-- 11 – 12 Diploma _____Yes -- No_____

College Name & Address
_____________________________________________________________________________
Did you receive a Degree? ________Yes---------No_____________ If yes, degree received:___________

Other Training: (graduate, technical, vocational):_____________________________________________

Awards, Honors, Special Achievements:____________________________________________________

APPLICANT SKILLS: Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability)

Skill ( ___ ) --------------------------------Years of Experience--------Rating

___________________________ _________________1__2__3__4__5

REFERENCES: List any two people who would be willing to provide a reference for you.

Name:_________________________________________________________

Address:_______________________________________________________

City/State/Zip:___________________________________________________
Relationship:____________________________________________________

Name:_________________________________________________________

Address:_______________________________________________________

City/State/Zip:__________________________________________________
Relationship:___________________________________________________

PLEASE PROVIDE ANY OTHER INFORMATION THAT YOU BELIEVE SHOULD BE CONSIDERED:

________________________________________________________________________________

CERTIFICATION

I certify that the information provided on this Application is truthful and accurate.I understand that providing false or misleading information will be the basis for rejection of my Application or if employment commences, immediate termination.

I authorize SAZ, INC. T/A TANGERINE ~ KAMAKURA ~ COCONUTS to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationships is created,I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be entirely voluntary in nature. In other words, with appropriate notice,I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer would have the same right. Moreover, no agent, representative, or employee of SAZ, Inc, T/A TANGERINE _ KAMAKURA ~ COCONUTS, except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

APPLICANT SIGNATURE__________________________________________ DATE_______________