Sample Employment Application Form

PLEASE PRINT ALL

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

1-7-16

PLEASE COMPLETE PAGES 1-4.

DATE ________________________________

Einertson

Allen

Joshua
Name ______________________________________________________________________________________________
Last

Present address

First

Number

Street

8 years
How long ____________________
Telephone ( 641
)

Middle

Maiden

50459
Northwood, Iowa
Nature Ave
329
______________________________________________________________________________________
City

State

Zip

Social Security No. _______ _____ _________

381-0222

If under 18, please list age _____________________

Days/hours available to work
X Thur ________
No Pref _______
Mon __________ Fri __________
Tue __________ Sat _________
Wed _________ Sun ________

Lifeguard
Position applied for (1) ________________________
Negotiable
and salary desired (2) ________________________
(Be specific)

I can not

Negotiable
How many hours can you work weekly? _________________________
Can you work nights? _______________________
Employment desired

X__ PART-TIME ONLY

__ FULL-TIME ONLY

__ FULL- OR PART-TIME

May 22
When available for work?_______________
____________________________________________________________________________________________________

TYPE OF SCHOOL

High School

NAME OF SCHOOL

Northwood Kensett

LOCATION
(Complete mailing
address)
1200 1st Ave N, Northwood, IA 50459

NUMBER OF YEARS
COMPLETED

3.5 years

MAJOR &
DEGREE

Diploma

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?

__ Yes __ No

2001 Mercury Cougar

What is your means of transportation to work? _______________________________________________________________

Drivers license
number ____________________________ State of issue _______
Expiration date ______________________

__ Operator __ Commercial (CDL)

__ Chauffeur

Have you had any accidents during the past three years?
Have you had any moving violations during the past three years?

How many? ___________________

0
How Many? ___________________

OFFICE ONLY

Typing

__ Yes
__ No

Personal
Computer

__ Yes
__ No

_____ WPM

__ Yes
10-key __ No

__ PC
__ Mac

Word
Processing

__ Yes
__ No

_____ WPM

Other _____________________________________________
Skills ______________________________________________

Please list two references other than relatives or previous employers.

Marty Cotter

Name _______________________________________

Teacher/Coach

Dave Capitani
Name _____________________________________________
Teacher /Coach

Position ______________________________________

Position ___________________________________________

Northwood Kensett High School

Company _____________________________________

Company __________________________________________

1200 1st Ave N, Northwood, IA 50459

Address ______________________________________

1200 1st Ave N, Northwood, IA 50459

Address ___________________________________________

______________________________________

___________________________________________

Telephone ( 641) 390-1147

Northwood Kensett High School

Telephone ( 641)

390-0640

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.

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?

__ Yes __ No
__ Yes __ No

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 Fallgatters

Address 98 7th St N, Northwood, IA 50459
City, State, Zip Code Northwood, Iowa 50459
Phone number

Name of last
supervisor

Kevin Petznik

641-324-1651

From 7-14-14
To

Your last job title

Reason for leaving (be specific)

Employment dates

5-10-16

Pay or salary
Start 7.25
Final 7.50

Carryout

Time management. Other job opportunities.

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

I was a carryout for 3 years. I learned how to fill products in a grocery store. I learned how to be a respectable
and good worker. I learned the value of time management and I was the leading carryout. A carryout that is
in charge of the other carryouts.

Name of employer Northwood Swimming Pool.

Address 627 Central Ave
City, State, Zip Code Northwood, Iowa, 50459
Phone number

(641) 324-1075

Name of last
supervisor

Employment dates

Pay or salary

Susan
Kliment

From 2015

Start 7.25

To Current

Final

Negotiable

Your Last Job Title Lifeguard

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.

I was a lifeguard. My duties where to watch over citizens as they swam. If they where to appear to not be able to
swim, I was to assist them. I learned CPR and the proper techniques to save someone when they where drowning.

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? _______________________________________________________________________________________