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Sample Employment Application Form

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Sample Employment Application Form

PLEASE PRINT ALL


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

PLEASE COMPLETE PAGES 1-4. 1/9/17


DATE ________________________________

Mix Jacob Christian


Name ______________________________________________________________________________________________
Last First Middle Maiden

99 11th street north 11th Northwood Iowa 50459


Present address ______________________________________________________________________________________
Number Street City State Zip

17 years
How long ____________________ Social Security No. _______ _____ _________

Telephone ( 641-904-6490
)
17
If under 18, please list age _____________________

Days/hours available to work


Dish Washer
Position applied for (1) ________________________ No Pref _______ Thur ________
8.50
and salary desired (2) ________________________ Mon __________ Fri __________
(Be specific) Tue __________ Sat _________
Wed _________ Sun ________

25
How many hours can you work weekly? _________________________ yes
Can you work nights? _______________________

Employment desired __ FULL-TIME ONLY x PART-TIME ONLY


__ __ FULL- OR PART-TIME
Monday-Friday
When available for work?_______________

____________________________________________________________________________________________________

TYPE OF SCHOOL NAME OF SCHOOL LOCATION NUMBER OF YEARS MAJOR &


(Complete mailing COMPLETED DEGREE
address)
High School Northwood-Kensett 704 7th Street North 3 years high school

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


__
My personal vehicle
What is your means of transportation to work? _______________________________________________________________

Drivers license
XXXXXXXXX
number ____________________________ IA
State of issue _______ __ Operator __ Commercial (CDL) __ Chauffeur
Expiration date ______________________

Have you had any accidents during the past three years? How many? No
___________________
Have you had any moving violations during the past three years? How Many? No
___________________

OFFICE ONLY

__ Yes __ Yes Word __ Yes


Typing __ No _____ WPM 10-key __ No Processing __ No _____ WPM

Personal __ Yes __ PC Other _____________________________________________


Computer __ No __ Mac Skills ______________________________________________

Please list two references other than relatives or previous employers.

Name _______________________________________ Name _____________________________________________

Position ______________________________________ Position ___________________________________________

Company _____________________________________ Company __________________________________________

Address ______________________________________ 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.
PLEASE PRINT ALL
INFORMATION REQUESTED
EXCEPT SIGNATURE
APPLICATION FOR EMPLOYMENT

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES? x No


__ Yes __

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD? x No


__ Yes __

Specialty ___________________________________ Date Entered ________________ Discharge Date ______________

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

Name of employer Manuel Ramirez Name of last Employment dates Pay or salary
Address 846 Central Ave, Northwood, IA 50459 supervisor
City, State, Zip Code Northwood iowa, 50459
From July 2014 Start 8.00
Phone number (641) 323-0000
To june 2017 Final 8.50

Your last job title dishwasher

Reason for leaving (be specific) entering military

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

Dishwasher, desert maker, janitorial work

Name of employer Name of last Employment dates Pay or salary


Address supervisor
City, State, Zip Code
From Start
Phone number
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 Please list your work experience for the past five years beginning with your most recent job held.
experience If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer Name of last Employment dates Pay or salary


Address supervisor
City, State, Zip Code
From Start
Phone number
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 Name of last Employment dates Pay or salary


Address supervisor
City, State, Zip Code
Phone number 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? _______________________________________________________________________________________

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