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.

Reyerson
Sully
Christian
Name ______________________________________________________________________________________________
Last

First

Middle

Maiden

405
Northwood, Iowa 50459
10th St N
Present address ______________________________________________________________________________________
Number

Street

City

18
How long ____________________

Telephone (

State

Zip

Social Security No. _______ _____ _________

If under 18, please list age _____________________

Days/hours available to work
X
No Pref _______
Thur ________
Mon __________ Fri __________
Tue __________ Sat _________
Wed _________ Sun ________

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

40
Yes
How many hours can you work weekly? _________________________
Can you work nights? _______________________

Employment desired

X FULL-TIME ONLY
__

__ PART-TIME ONLY

__ FULL- OR PART-TIME

When available for work?_______________

____________________________________________________________________________________________________

TYPE OF SCHOOL

High School

NAME OF SCHOOL

LOCATION
(Complete mailing
address)

Northwood - Kensett

704 7th St. N

NUMBER OF YEARS
COMPLETED
3.5

MAJOR &
DEGREE
Diploma, May 2016

Northwood, IA 50459

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
__

98 Oldsmobile Intrigue
What is your means of transportation to work? _______________________________________________________________

Drivers license
IA
XXXXXXXXX
number ____________________________
State of issue _______
XXXXXXXXX
Expiration date ______________________
Have you had any accidents during the past three years?
Have you had any moving violations during the past three years?

__ Operator __ Commercial (CDL)

__ Chauffeur

No accidents
How many? ___________________
No moving violations
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.

Deb Faugstad
Name _______________________________________

Amy Renwick
Name _____________________________________________

K-12 Language Arts Chair/ 7-12 English Teacher

Position ______________________________________

Guidance Counselor
Position ___________________________________________

Northwood-Kensett High School

Company _____________________________________

Northwood-Kensett High School

Company __________________________________________

704 7th St. N Northwood, IA 50459

Address ______________________________________

704 7th St. N Northwood, IA 50459

Address ___________________________________________

______________________________________

___________________________________________

Ext. 109
Telephone ( 641-324-2142,
)

Ext. 117
Telephone ( 641-324-2142,
)

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?

X Yes __ No
__
X Yes __ No
__

March 2015
Motor Transport Operator
Specialty ___________________________________
Date Entered ________________
Discharge Date ______________
N/A

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

Lutheran Retirement Home

701-9th Street North
Northwood, Ia, 50459
(641) 324-1712

Name of last
supervisor

Employment dates

Nancy Franck

From July 2013

Start $8.25

To

Final $9.90

May 2015

Pay or salary

Your last job title Dietary Aid/Kitchen Aid

Reason for leaving (be specific) Left for Army Basic Training
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.

I was a dish washer, I prepared food, served food, washed dishes, stocked food inventory, and mopped floors.
From good working skills and trustworthiness I received two raises in pay. I was also sought after by my coworkers
because I was a very reliable worker and with being trained in several different parts of the kitchen I could help my coworkers when needed.
Job required quite a bit of patience and a lot of temper control since dealing with older residents can be quite a handful. Also I learned good
teamwork skills as well as good social skills.

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? _______________________________________________________________________________________