Job Application to work at

Maui Soda and Ice Works Ltd.

Applicant Information

Name*:

Email*:

Address*:

City:

State:

Zip Code:

Phone Number:

Do you have a valid driver’s license?*YesNo

State/License #:

Have you ever applied to or worked for MSIW?*YesNo

If yes, when?

Do you have any friends/relatives working for MSIW?*YesNo

If yes, state name and relationship:

How did you hear about us/this opening?

State briefly why you would like to work for Maui Soda & Ice Works, Ltd.

Special Skills

Do you have any experience, training, qualifications or skills which you feel make you especially suited to work at Maui Soda & Ice Works, Ltd.? If so, explain in detail below. Please include average operational time spent in operation of a Commercial Vehicle (CDL).

Computer Skills

Dates Used

Level of Proficiency

Employment History

List all previous employers starting with your present or most recent position (last ten years is sufficient).

Name of Company 1

Address:

Name of Supervisor:

Telephone Number:

Start Date:

End Date:

Position:

Duties:

Reason for Leaving:

Name of Company 2

Address:

Name of Supervisor:

Telephone Number:

Start Date:

End Date:

Position:

Duties:

Reason for Leaving:

Employment History (continued)

List all previous employers starting with your present or most recent position (last ten years is sufficient).

Name of Company 3

Address:

Name of Supervisor:

Telephone Number:

Start Date:

End Date:

Position:

Duties:

Reason for Leaving:

Name of Company 4

Address:

Name of Supervisor:

Telephone Number:

Start Date:

End Date:

Position:

Duties:

Reason for Leaving:

Name of Company 5

Address:

Name of Supervisor:

Telephone Number:

Start Date:

End Date:

Position:

Duties:

Reason for Leaving:

References

References Give the names of three persons not related to you, whom you have known at least three (3) years.

Name

Address, Phone, Email

Company

Years Acquainted

Maui Soda and Ice Works, Ltd. is an Equal Opportunity Employer. Race, color, religion, age, sex, disability, marital or veteran status, place of national origin, and other categories protected by law are not factors in employment, promotion, compensation or working conditions.

Please read and initial each paragraph below (After reading each of the following statements, please type your initials agreeing that you have read and understand each statement.).

I hereby authorize Maui Soda & Ice Works, Ltd. to thoroughly investigate my references, work records, education, and other matters related to my suitability for employment and further authorize my current and former employers to disclose to the company any and all letters, reports, and other information pertaining to my employment with them without giving me prior notice of such disclosure. In addition, I hereby release Maui Soda & Ice Works, Ltd., my current and former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.*

I understand that if offered employment, the offer may be contingent on my passing a pre-employment alcohol and drug screen and a pre-employment physical. By signing this application, I voluntarily agree to submit to a pre-employment alcohol/drug screen and pre-employment physical upon request. I understand that failure to pass the alcohol/drug screen and/or physical will result in withdrawal of the employment offer.*

If hired, I also agree to submit to alcohol or drug testing as a condition of employment. I agree that Maui Soda & Ice Works, Ltd. may conduct alcohol or drug screening at its sole discretion with or without notice. I also understand that refusal to submit to an alcohol/drug screen will be considered a voluntary resignation of employment.*

I understand that if offered employment, Maui Soda & Ice Works, Ltd. may inquire into and consider any criminal conviction record that I may have after it makes a conditional offer of employment to me. Maui Soda & Ice Works, Ltd. may withdraw a conditional employment offer if I have a criminal conviction record which bears a rational relationship to the duties and responsibilities of the position for which I am applying. Any criminal conviction record that is more than 10 years old or that involves certain Family Court matters will not be considered.*

I understand that nothing contained in the application or conveyed to me during any interview which may be granted is intended to create an employment contract, implied or explicit, between me and Maui Soda & Ice Works, Ltd.. In addition, I understand and agree that if I am employed, my employment relationship with Maui Soda & Ice Works, Ltd. is strictly voluntary and at our mutual will. I understand that if employed, my employment is for no definite period and may be terminated at any time, with or without prior notice, with or without cause or reason, at the option of either myself or Maui Soda & Ice Works, Ltd., and that no promises or representations contrary to the forgoing are binding on Maui Soda & Ice Works, Ltd. unless made in writing and signed jointly by the President/CEO and myself.*

I understand and agree that any future changes in my title, duties, compensation, working conditions, and/or Maui Soda & Ice Works, Ltd. benefits, policies, and procedures will not alter our will and arbitration agreements.*

I understand that if offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United States on my first day of employment.*

If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid Hawai`i driver’s license and understand that I will be required to provide a copy of my official driving record and proof of insurance. I also understand that any offer of employment is contingent on my ability to be covered by Maui Soda & Ice Works, Ltd. auto insurance, if required for my position.*

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement on this application or on any documents used to secure employment shall be grounds for rejection of this application or for immediate discharge is I am employed, regardless of the time elapsed before discovery.*

I confirm

My signature below certifies that I have read and understand this complete page and agree to the terms and conditions outlined in this document.*

Applicant’s Signature

Date

Job Application

Job Application to work at

Maui Soda and Ice Works Ltd.

Applicant Information

General Information about Employment Desired

*if required for the position you are seeking

Education and Training (include on-the-job training)

Special Skills

Employment History

Employment History (continued)

References

Please read and initial each paragraph below (After reading each of the following statements, please type your initials agreeing that you have read and understand each statement.).