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Employment Application
Name:
Nagle

COMPANY OR EMPLOYER NAME:

Dave Tenold's farm

Position applying for:

Farm help

EMPLOYEE INFORMATION
Jeremy Scott

Last Telephone: 641-390-2367 Address:

First Email: 14jnagle@hotmail.com

Middle Alternate telephone: 641-324-1352

872 450th Street, Northwood, Iowa 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 Work overtime? Yes Provide a valid Alaska Driver's License? If so, fill out the following: Issuing state: Type: Endorsement(s):
Hazardous Material Tankers School Bus Any Split Day Night Other:

No No

Passengers

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

Tank with Hazardous Materials Double/Triple trailers Swing Rotating

Work the following shifts: (check all that apply)

Graveyard

I will be able to report to work 3 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 1423 450th Ave. Northwood, Iowa 50459

Position title/duties, skills:

Washed dish's and put them in their appropriate places Swept floors

Start date:
April 2013

End date:
July 2013

Reason for leaving:

Pay: $ 9.07 Per: Hour Employer name and address:

Supervisor: Joey hanson Position title/duties, skills:

Telephone: 1877-323-5566

Pursuing other opportunities

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: 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:

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

Years completed
3
General

Field of study

Graduate or degree
May 2014

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:
Very hands-on. Can communicate with anybody.

Types of computers, software, and other equipment you are qualified to operate or repair:
N/A

Professional licenses, certifications or registrations:

N/A

Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employers attention:
Have grown up on a farm and have many farming skills

Typing speed:

60

per minute

REFERENCES
List two personal references who are not relatives or former supervisors.
Noel Kramer Name Robin Baurs Name

710 7th St. North, Northwood, Iowa 50459 Address

641-324-8563 Telephone 641-324-5678 Telephone

Public health nurse Occupation Day care Occupation

10

Years known
18

147 8th. North, Northwood, Iowa 50459 Address

Years known

CONTACT
In case of accident or illness, please contact: Name: Dennis Nagle Address: 872 450th Northwod, Iowa 50459 Daytime phone: 641-390-1214 Relationship: father

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.
Jeremy Nagle February 7 2014

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