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PERSONAL INFORMATION Date - -

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Sam Choy’s Kai Lanai
is an equal opportunity employer.
Various federal, state and local laws prohibit discrimination based on race, color, sex,
religion, national origin, ancestry, age disability, marital status or any other protected
basis. Sam Choy’s Kai Lanai is an equal opportunity employer and your response to
any question will not be used as a basis for discrimination, but will be judged on its
relevance to the position your are seeking. Sam Choy’s Kai Lanai is a Drug-Free
Workplace.
78-6831 Ali'i Drive Suite 1000 | Kailua Kona HI 96740 | 808.333.3434 | www.samchoy.com
PERSONAL INFORMATION Date - -
Name (Last) (First) (Middle)
Home Address City State Zip
Home Phone Mobile Phone Business Phone May we contact you at work?
Yes No
Position Applying For: Date Available
- -
Are you interested in (check all that apply)
Part-time Temporary Casual Seasonal
Days and hours available – Complete if applying for a restaurant position
Day
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
From
To
Are you 18 years of age or over? Yes No
Note: if a minor, work permit is required upon hire
Are you eligible to be lawfully employed in the U.S.?
Yes No
How where you referred to Sam Choy’s Kai Lanai?
_______________________________________________________________________________________________________________________
EDUCATION
Type of School
Degree/Area of
Study
Number of
Years
Attended
Graduated
(Check One)
High School
Yes No
College
Yes No
Graduate School
Yes No
Other
Yes No
U. S. MILITARY SERVICE
Branch of Service
Technical Specialization
Rank Attained
LEGAL
Are you a U.S. Citizen or do you have a legal right and necessary documents to work in the U.S.? Yes No
(Identity and employment eligibility of all new hires will be verified as required by the Immigration Reform and Control Act of 1986.)
Were you ever discharged by a company? Yes No If yes, give name of company(ies): _________________________________________
Reason for discharge: _____________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
EMPLOYMENT HISTORY
List employment starting with your most recent position. Account for any time during this period that you were unemployed by stating the nature
of your activities. May we contact your present employer? Yes No Past Employer? Yes No Please indicate if you were
employed under a different name: __________________________________________________________________________________________
DATES
NAME AND ADDRESS OF EMPLOYER
POSITION HELD
AND
SUPERVISOR
LIST MAJOR
DUTIES
SALARY OR WAGES
REASON
FOR
LEAVING
From:
/
Mo. Yr.
To:
/
Mo. Yr.
Name:
_________________________________
Address: City:
____________________
____________
State: ___________ Zip: ____________
Phone: __________________
Your Job Title
Supervisor
Starting:
Final:
From:
/
Mo. Yr.
To:
/
Mo. Yr.
Name:
_________________________________
Address: City:
____________________
____________
State: ___________ Zip: ____________
Phone: __________________
Your Job Title
Supervisor
Starting:
Final:
From:
/
Mo. Yr.
To:
/
Mo. Yr.
Name:
_________________________________
Address: City:
____________________
____________
State: ___________ Zip: ____________
Phone: __________________
Your Job Title
Supervisor
Starting:
Final:
From:
/
Mo. Yr.
To:
/
Mo. Yr.
Name:
_________________________________
Address: City:
____________________
____________
State: ___________ Zip: ____________
Phone: __________________
Your Job Title
Supervisor
Starting:
Final:
Have you previously worked for Great Western Restaurants, Inc. or a Sam Choy restaurant concept? Yes No If yes:
Name: _______________________________________________________
Location: ____________________________________________
City & State: ___________________________________________________
Position Held: _________________________________________
Supervisor: ____________________________________________________
Dates Employed: From: _____________ To: ________________
Reason for leaving: _______________________________________________________________________________________________________
REFERENCES
Business references: (do not list relatives) (please indicate if you were employed under a different name)
Name
Address
Work Phone #
Title
Years Known
- -
- -
- -
PLEASE READ CAREFULLY
I understand that, with my authorization, an investigation may be made whereby information is obtained regarding my character, previous
employment, general reputation, educational background, credit record and/or criminal history, subject to applicable federal, state and/or local
laws.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate
dismissal. I understand, also, that I am required to abide by all rules and regulations of Great Western Restaurants, Inc., Kona Daze LLC dba Sam
Choy’s Kai Lanai.
I understand and agree that, if employed, the employment will be “at will”. That is, either I or Great Western Restaurants, Inc., Kona Daze LLC dba
Sam Choy’s Kai Lanai may end the employment relationship at any time, for any reason, or for no reason. I understand that receipt of this
application by Kona Daze LLC dba Sam Choy’s Kai Lanai does not imply employment and that this application and/or any other Great Western
Restaurants, Inc., Kona Daze LLC dba Sam Choy’s Kai Lanai documents are not contracts of employment.
APPLICANT’S SIGNATURE DATE
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Completed 9 February 2021

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