This application is for the position of Certified Nursing Assistant (CNA) and includes basic personal information such as name, address, availability, and references. The applicant's only work experience listed is umpiring softball games in the summer of 2016. No other employers or work history in the past 5 years is included. Education consists of graduating high school in 2016 with a diploma. The applicant has not been convicted of any crimes and has a valid driver's license with their own vehicle for transportation.
This application is for the position of Certified Nursing Assistant (CNA) and includes basic personal information such as name, address, availability, and references. The applicant's only work experience listed is umpiring softball games in the summer of 2016. No other employers or work history in the past 5 years is included. Education consists of graduating high school in 2016 with a diploma. The applicant has not been convicted of any crimes and has a valid driver's license with their own vehicle for transportation.
This application is for the position of Certified Nursing Assistant (CNA) and includes basic personal information such as name, address, availability, and references. The applicant's only work experience listed is umpiring softball games in the summer of 2016. No other employers or work history in the past 5 years is included. Education consists of graduating high school in 2016 with a diploma. The applicant has not been convicted of any crimes and has a valid driver's license with their own vehicle for transportation.
This application is for the position of Certified Nursing Assistant (CNA) and includes basic personal information such as name, address, availability, and references. The applicant's only work experience listed is umpiring softball games in the summer of 2016. No other employers or work history in the past 5 years is included. Education consists of graduating high school in 2016 with a diploma. The applicant has not been convicted of any crimes and has a valid driver's license with their own vehicle for transportation.
INFORMATION REQUESTED EXCEPT SIGNATURE APPLICATION FOR EMPLOYMENT APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS
1/7/16 DATE ________________________________
PLEASE COMPLETE PAGES 1-4.
Low Renae Shelby Name ______________________________________________________________________________________________ Last
First
Middle
Maiden
4636 Pheasant Ave Northwood, IA 50459 Present address ______________________________________________________________________________________ Number
Street
City
State
Zip
XXXX XX _________ xxx _____ Social Security No. _______
18 years How long ____________________ Telephone (xxx-xxx-xxxx )
NA If under 18, please list age _____________________ Days/hours available to work No Pref _______ Thur ________ Mon __________ Fri __________ Tue __________ Sat _________ X Wed _________ Sun ________ X
CNA Position applied for (1) ________________________ Negotiable and salary desired (2) ________________________ (Be specific)
How many hours can you work weekly? _________________________
Can you work nights? _______________________ 16 Yes Employment desired
__ FULL-TIME ONLY
X PART-TIME ONLY __
__ FULL- OR PART-TIME
Weekends When available for work?_______________ ____________________________________________________________________________________________________
TYPE OF SCHOOL
High School
NAME OF SCHOOL
Northwood-Kensett
College
NA
Bus. or Trade School
NA
Professional School
NA
LOCATION (Complete mailing address) 704 7th St N, PO Box 289
HAVE YOU EVER BEEN CONVICTED OF A CRIME?
__ X No
NUMBER OF YEARS COMPLETED
3.5 years
MAJOR & DEGREE High School Diploma, May 2016
__ 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
I have my own vehicle
What is your means of transportation to work? _______________________________________________________________ Drivers license Iowa XXXXXXXXX number ____________________________ State of issue _______ Expiration date ______________________ xx/xx/xxxx Have you had any accidents during the past three years? No Have you had any moving violations during the past three years?
No
X Operator __ Commercial (CDL)
__
__ Chauffeur
How many? ___________________
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.
Amy Renwick Name _______________________________________
Deb Faugstad Name _____________________________________________
School Counselor Position ______________________________________
Teacher Position ___________________________________________
Northwood Kensett High School
Company _____________________________________
Northwood Kensett High School
Company __________________________________________
Northwood, IA 50459 ______________________________________
Northwood, IA 50459 ___________________________________________
Telephone XXX-XXX-XXXX ( )
Telephone (XXX-XXX-XXXX )
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 __ X No __ Yes __ X No
NA Specialty ___________________________________ Date Entered ________________ Discharge Date ______________ NA NA 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 City of Northwood
Address 427 Central Ave City, State, Zip Code Northwood, IA 50459 Phone number
641-324-1075
Name of last supervisor
Taryn Van Ryswk From June
To July Your last job title
Reason for leaving (be specific)
Employment dates
Pay or salary Start
$15/game
Final
$15/game
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Umpired peewee and midget softball games in Swensrud Park. I learned how to work well with younger children and some other adults if they didnt agree with the calls I made.
Name of employer Address City, State, Zip Code Phone number
Name of last supervisor
NA
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
NA
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
NA
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 NA
Did you complete this application yourself
__ X Yes __ No
If not, who did? _______________________________________________________________________________________
