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Employment Application
Name: Bachtle Last Telephone: 888-888-8888 Address:
John

COMPANY OR EMPLOYER NAME:

Diamond Jo Casino Worth

Position applying for: Supervisor

EMPLOYEE INFORMATION
Gary

First Email: noname@gmail.com

Middle Alternate telephone: 555-555-5555

1234 123 Street, Northwood, IA 50459

Are you able to perform the essential functions of the position with or without accommodations?
Yes 14 18 Yes No 15 19 No Yes No 16 21 (Check one)

If necessary for the job are you older than:

If necessary for the job, I am able to: Yes No Work overtime? Yes No Provide a valid Alaska Driver's License? Iowa If so, fill out the following: Issuing state: Class-C Type: Endorsement(s):
Hazardous Material Tankers School Bus Any Split Day Night Other: Passengers Tank with Hazardous Materials Double/Triple trailers Swing Rotating

I am legally eligible for employment in the U.S.? I am seeking a permanent position:

Work the following shifts: (check all that apply)

Graveyard

I will be able to report to work 5 days after being notified I am hired.

EMPLOYMENT HISTORY
List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.

Employer name and address:

Diamond Jo Casino Worth 777 Diamond Jo Lane Northwood, IA 50459 Pay: $ 6.00

Position title/duties, skills:

Wait tables, seat customers, serve and prepare drinks, and check IDs.

Start date:
3-3-13

End date:
Present

Reason for leaving:

Job change
Supervisor: Kathy Jorgenson Position title/duties, skills: Telephone: 999-999-9999 Start date:
June

Per: Hour Employer name and address:

City of Northwood 627 Central Avenue Northwood, IA 50459 Pay: $ 7.25

End date:
August

Scan pool for distressed swimmers, clean bathrooms, teach swimming lessons, alert and perform medical help, CPR and First Aid certied.

Per: Hour Employer name and address:

Supervisor: Dedra Harris Position title/duties, skills:

Telephone: 222-222-2222

Reason for leaving: Seasonal Employment summers 2012 & 2013 Start date: End date:

Reason for leaving: Pay: $ Per: Employer name and address:

Supervisor: Position title/duties, skills:

Telephone: Start date: End date:

Reason for leaving: Pay: Per: $ Supervisor: Telephone:

Employment Application Page 1 of 2

Rev. 8/2010

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Summarize other employment related to this job: No supervisor experience, but currently work for the company.

EDUCATION
Institution name High school College/university Business/technical Additional
Northwood-Kensett HS

Years completed
3.5

Field of study
General/Business

Graduate or degree
Expected HS diploma 5/18/14

MILITARY
Are you a veteran? Duty/specialized training: Yes No

SKILLS & QUALIFICATIONS

Other qualifications such as special skills, abilities or honors that should be considered:
Good leadership and communication skills. Excellent computer and typing skills.

Types of computers, software, and other equipment you are qualified to operate or repair:
Capable of operating both Macs and PCs. Familiar with standard software ex. (Word, Excel, Powerpoint, Pages, Keynote, Numbers)

Professional licenses, certifications or registrations:

CPR and First Aid certied.

Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employers attention:
Very familiar with both the job and employees. Already understand what the job title consists of. Have personal experience with the customers. Typing speed: 68 per minute

REFERENCES
List two personal references who are not relatives or former supervisors.
Mindy Tenold Name Jennifer Otten Name 123 Fake Road, Northwood, IA 50459 Address 456 Red Street, Rockwell IA, 50469 Address 777-777-7777 Telephone 444-444-4444 4-H Youth Coordinator Occupation Teacher Occupation 9 years Years known

Telephone

6 years Years known

CONTACT
In case of accident or illness, please contact: Name: Michele Bachtle Address: 1111 Orange Street, Northwood IA, 50459 Daytime phone: 888-888-8888 Relationship: Mother

INFORMATION TO THE APPLICANT

As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references. If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above. John G Bachtle

2-5-14

Signature of Applicant

Date

Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment. Developed at employer request by the Alaska Department of Labor & Workforce Development, Employment Security Division. Rev. 8/2010 Employment Application Page 2 of 2