Sample Employment Application Form

PLEASE PRINT ALL

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

1/7/16
DATE ________________________________

PLEASE COMPLETE PAGES 1-4.

Daniel
N/A
Thomas
Yezek
Name ______________________________________________________________________________________________
Last

Present address

First

Middle

Maiden

1907
420th st
Kensett Iowa 50448
______________________________________________________________________________________
Number

Street

18 Years
How long ____________________

City

State

Zip

xxxxx
xxxxx xxxxx
Social Security No. _______
_____ _________

Telephone (xxx-xxx-xxxx
)

N/A
If under 18, please list age _____________________
Days/hours available to work
x
No Pref _______
Thur ________
Mon __________ Fri __________
Tue __________ Sat _________
Wed _________ Sun ________

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

Yes

37
How many hours can you work weekly? _________________________
Can you work nights? _______________________
Employment desired

x FULL-TIME ONLY
__

__ PART-TIME ONLY

__ FULL- OR PART-TIME

immediately
When available for work?_______________
____________________________________________________________________________________________________

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION
(Complete mailing
address)
704 7th St. North

NUMBER OF YEARS
COMPLETED

MAJOR &
DEGREE
Diploma may 2016

High School

Northwood Kensett

College

N/A

N/A

N/A

N/A

Bus. or Trade School

N/A

N/A

N/A

N/A

Professional School

N/A

N/A

N/A

N/A

HAVE YOU EVER BEEN CONVICTED OF A CRIME?

x No
__

3 1/2 years

__ 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
__

My families chevy suburban

What is your means of transportation to work? _______________________________________________________________
Drivers license
X
IA
number ____________________________
State of issue _______
x
Expiration date ______________________

x Operator __ Commercial (CDL)

__

__ Chauffeur

No
How many? ___________________
No
How Many? ___________________

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

Lee Okerlund
Name _______________________________________

Kent Nitcher
Name _____________________________________________

Teacher
Position ______________________________________

Janitor
Position ___________________________________________

Northwood Highschool
Company _____________________________________

Northwood Highschool
Company __________________________________________

704 7th St. North

Address ______________________________________

704 7th St. North

Address ___________________________________________

______________________________________

___________________________________________

Telephone (

Telephone (

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.

Ex Janitorial worker, current carry out at Fallgaters Market.

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 __

N/A
N/A
N/A
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
Address
City, State, Zip Code
Phone number

Name of last
supervisor

Kevin

Employment dates
From July

1st

To

Your last job title

Reason for leaving (be specific)

Present
Carry out

Pay or salary
Start

7.25

Final

7.25

Amount being paid

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

How to communicate with angry people, how to restock shelves, how to carry out

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.

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?

x Yes __ No
__

Did you complete this application yourself

x Yes __ No
__

If not, who did? _______________________________________________________________________________________