JTB Hawaii, Inc. Group

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1 JTB Hawaii, Inc. Group JTB Hawaii, Inc. JTB Hawaii Travel, LLC JTB Global Travel Services, LLC Travel Plaza Transportation, LLC Tachibana Enterprises, LLC Date: Position you are applying for: (Must be filled in) Application for Employment Name Phone: EMPLOYMENT RECORD: Starting with present or MOST RECENT, list all previous employers. Include selfemployment, seasonal, and part-time jobs. Please attach additional sheets if necessary, following the same format. Name & of Former Employer Dates Employed Position Reason for Leaving AVAILABLE WORK HOURS: On each day, write what hours you are available to work. If you are available to work any time on a particular day, please write ALL DAY. If you are not available to work on certain days, please write Not Available. If you are available for shift work, please list all hours available. SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

2 PROFESSIONAL REFERENCES (Not relatives) Must be a person whom you have known for at least 1 year Name Relationship Phone Number Name Relationship Phone Number Name Relationship Phone Number EDUCATION: High School Name of School No. of Yrs. Attended College Name of School No. of Yrs. Attended Other Name of School No. of Yrs. Attended Degree(s) Degree(s) Degree(s) SKILLS: List all job related certifications and skills including, if applicable, all computer programs/software you currently use: MEDICAL INFORMATION: After an offer of employment is made, but before employment duties begin, applicants may be required to undergo a physical or medical examination (or drug test) at the Company's expense and by a Company-chosen physician, with the offer of employment conditioned on the result of such examination. Employees may also be required,during the course of their employment, to undergo a medical (or drug) examination at the Company's expense and by a Company-chosen physician. Are you able to perform the essential functions of this job with or without reasonable accommodation? OTHER: How did you hear about this job opportunity? Source(Newspaper, Online etc): Can you furnish proof of your eligibility to work in the United States?(Check one) Yes No Do you know anyone presently working for our company (including JTB Hawaii, JTB Hawaii Travel, JTB Global Services, Travel Plaza Transportation, Tachibana Enterprises)? Employee Name: Did you previously work for our company (including JTB Hawaii, JTB Hawaii Travel, JTB Global Services, Travel Plaza Transportation, Tachibana Enterprises)? If so, please provide the Company Name &the dates of Employment: Have you ever applied to our company (including JTB Hawaii, JTB Hawaii Travel, JTB Global Services, Travel Plaza Transportation, Tachibana Enterprises) before? If so, please provide the Company Name & date(s) applied? :

3 NOTE: It is the policy of this Company to hire only individuals who are authorized to work in this country. (If you are hired, you will be required to produce original documents establishing your identity and authorization to work in the United States, and to complete the Department of Homeland Security U.S Citizenship and Immigration Services Form I-9 within three business days of employment.) By signing below, I certify that all statements made on this application are true and complete to the best of my knowledge. I understand that my application will not be considered if it is incomplete. Further, I understand that any misrepresentation or omission made herein, when discovered, may result rejection of my application for employment or my immediate discharge if I am employed by the Company. I authorize the Company to investigate my work history, education, character, reputation, and background as it deems necessary for purposes of considering my application for employment. I hereby release the Company, its representatives, and all providers of information (including, but not limited to, any of my former employers, educational institutions attended, and personal references) from all liability relating to or arising out of any inquiry by the Company regarding my work history, education, character, reputation and background. This application is not a contract of employment and cannot create a contract of employment for any specific period. I understand that if I am employed, my employment is at-will and can be terminated at any time, either by myself or the Company, with or without cause or reason and with or without notice. Applicant Signature Application Date Please submit application via at jobs@jtb-hawaii.com mail to JTB Hawaii, Inc attn: Human Resource Dept. 818 Pine Street 4 th floor Honolulu, HI or fax at

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6 NEW APPLICANT PRELIMINARY QUESTIONS Name: Date: 1) Job or position applied for: 2) Language abilities: (Check one and/or more if applicable) English Speaking fluent some Japanese Speaking fluent some Korean Speaking fluent some Chinese Speaking fluent some Mandarin Cantonese Simplified Traditional 3) Computer skills: Word Excel PowerPoint Other: 4) 10-key skills: Yes ( by touch by sight) No 5) Convenient time for a job interview: a.m. p.m. Date: 6) If hired, when are you available to start? 7) Do you know anyone currently working for our company? If so, please state name(s) 8) Referred by: Employment Agency name Newspaper name Others Prelim Q New App 044 (Rev. 8/2009)