Sample Employment Application Form

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE
APPLICATION FOR EMPLOYMENT
APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

1/8/15
DATE ________________________________

PLEASE COMPLETE PAGES 1-4.

Fridley
Lance
Caperton
Name ______________________________________________________________________________________________
Last

First

Middle

Maiden

409
9th Street North
Northwood IA 50459
Present address ______________________________________________________________________________________
Number

Street

6 Years
How long ____________________

City

State

Zip

xxxx
xxx _________
xxxx
Social Security No. _______
_____

Telephone (641) 583 3903

18
If under 18, please list age _____________________
Days/hours available to work
4pm-10pm
No Pref _______ Thur ________
4pm- 10pm Fri __________
4pm-10pm
Mon __________
4pm- 10pm Sat _________
4pm-10pm
Tue __________
4pm-10pm
- 10pm Sun ________
Wed 4pm
_________

Cook
Position applied for (1) ________________________
8.25
and salary desired (2) ________________________
(Be specific)

35 Hours
Yes
How many hours can you work weekly? _________________________
Can you work nights? _______________________
Employment desired

__ FULL-TIME ONLY

x PART-TIME ONLY
__

__ FULL- OR PART-TIME

ASAP
When available for work?_______________
____________________________________________________________________________________________________

TYPE OF SCHOOL

High School

NAME OF SCHOOL

LOCATION
(Complete mailing
address)
Northwood-Kensett HS 1200 1st Avenue North

NUMBER OF YEARS
COMPLETED
3

MAJOR &
DEGREE
general

College
Bus. or Trade School
Professional School

HAVE YOU EVER BEEN CONVICTED OF A CRIME?

x No
__

__ Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were
committed, sentence(s) imposed, and type(s) of rehabilitation. __________________________________________________
____________________________________________________________________________________________________

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE
APPLICATION FOR EMPLOYMENT

DO YOU HAVE A DRIVERS LICENSE?

__
x Yes __ No

Car
What is your means of transportation to work? _______________________________________________________________
Drivers license
XXXXXXXXXX
IA
number ____________________________
State of issue _______
Expiration date ______________________
1/27/2015
Have you had any accidents during the past three years?
Have you had any moving violations during the past three years?

x Operator __ Commercial (CDL)

__

__ Chauffeur

0
How many? ___________________
1
How Many? ___________________

OFFICE ONLY

Typing

x Yes
__
__ No

Personal
Computer

x Yes
__
__ No

55 WPM
_____

__ Yes
x No
10-key __

__ PC
x Mac
__

Word
Processing

x Yes
__
__ No

55 WPM
_____

Text
Other _____________________________________________
Skills ______________________________________________

Please list two references other than relatives or previous employers.

Mark Willand
Name _______________________________________

Dave Waters
Name _____________________________________________

Youth Director
Position ______________________________________

Nordic Lanes Owner

Position ___________________________________________

First Lutheran Church

Company _____________________________________

Bowling Alley
Company __________________________________________

309 9th Street North

Address ______________________________________

1003 8th Street North

Address ___________________________________________

Northwood Iowa
______________________________________

Northwood Iowa
___________________________________________

Telephone (641
(
) 324-2984

Telephone (641
(
) 324-2749

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the
space below to summarize any additional information necessary to describe your full qualifications for the specific position for
which you are applying.

I work at a bowling alley where I cook and serve food. I catch on to things very quick.

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE
APPLICATION FOR EMPLOYMENT
MILITARY
HAVE YOU EVER BEEN IN THE ARMED FORCES?
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?

x No
__ Yes __
x No
__ Yes __

Specialty ___________________________________ Date Entered ________________ Discharge Date ______________

Work
Experience

Please list your work experience for the past five years beginning with your most recent job held.
If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer Nordic Lanes

Address
City, State, Zip Code Northwood IA 50459
Phone number

Name of last
supervisor

Linda
Waters
Your last job title

Reason for leaving (be specific)

Employment dates

Pay or salary

From

Start

8.25

To

Final

8.50

06/2014
present

Cook

Presently employed

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.

Cook, Dishwasher, and Server

Name of employer Fallgatters

Address
City, State, Zip Code Northwood
Phone number

IA 50459

Name of last
supervisor

Employment dates

Kevin
Petznick

From

Your Last Job Title

Reason for leaving (be specific)

To

3/2013
5/2014

Pay or salary

6.25
Final 7.25
Start

Carryout

Found better job, with better management

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.

Carried out bags, stocked shelfs and bottle return customer service

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE
APPLICATION FOR EMPLOYMENT
Work
experience

Please list your work experience for the past five years beginning with your most recent job held.
If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer
Address
City, State, Zip Code
Phone number

Name of last
supervisor

Employment dates

Pay or salary

From

Start

To

Final

Your last job title

Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.

Name of employer
Address
City, State, Zip Code
Phone number

Name of last
supervisor

Employment dates

Pay or salary

From

Start

To

Final

Your last job title

Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.

May we contact your present employer?

__ Yes __ No

Did you complete this application yourself

__ Yes __ No

If not, who did? _______________________________________________________________________________________