Sample Employment Application Form

PLEASE PRINT ALL

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

1.18.2016
DATE ________________________________

PLEASE COMPLETE PAGES 1-4.

Jo
Katherine
Schiltz
Name ______________________________________________________________________________________________
Last

First

Middle

Maiden

84444
130th Street
Glenville, MN 56036
Present address ______________________________________________________________________________________
Number

Street

City

State

Zip

xxxx
xx
xxxx _____
Social Security No. _______
_________

18 years
How long ____________________
Telephone ( xxx) -xxx-xxxx

N/A
If under 18, please list age _____________________
Days/hours available to work
x
No Pref _______
Thur ________
Mon __________ Fri __________
Tue __________ Sat _________
Wed _________ Sun ________

customer service staff

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

yes
15
How many hours can you work weekly? _________________________
Can you work nights? _______________________
Employment desired

x PART-TIME ONLY
__

__ FULL-TIME ONLY

__ FULL- OR PART-TIME

after school hours and weekends

When available for work?_______________
____________________________________________________________________________________________________

TYPE OF SCHOOL

NAME OF SCHOOL

High School

Northwood-Kensett

College

North Iowa Area

Community College

LOCATION
(Complete mailing
address)
704 7th St. N
Northwood, IA 50459
500 College Dr, Mason City,
IA 50401

NUMBER OF YEARS
COMPLETED
3.5

MAJOR &
DEGREE
Diploma, May 2016
N/A

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
__

personal vehicle
What is your means of transportation to work? _______________________________________________________________
Drivers license
MN
xxxxxxxxxxxx
number ____________________________
State of issue _______
xx/xx/xxxx
Expiration date ______________________
Have you had any accidents during the past three years?
Have you had any moving violations during the past three years?

x Operator __ Commercial (CDL)

__
How many?
How Many?

__ Chauffeur

0
___________________
1
___________________

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.

Morgan Johnson
Name _______________________________________

Deb Faugstad
Name _____________________________________________

Library associate
Position ______________________________________

Language Arts Chair/ 7-12 English Teacher

Position K-12
___________________________________________

Northwood-Kensett Junior Senior High SchoolCompany __________________________________________

Northwood-Kensett Junior Senior High School
Company _____________________________________
1200 1st Ave N, Northwood, IA 50459
Address ______________________________________

1200 1st Ave N, Northwood, IA 50459

Address ___________________________________________

______________________________________

___________________________________________

Telephone ( 641-324-2142
)

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 No
__ Yes __

x No
__ Yes __

NA
NA
NA
Specialty ___________________________________
Date Entered ________________
Discharge Date ______________
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
627 Central Ave
City, State, Zip Code Northwood, IA, 56037
Phone number 641-324-1075

Name of last
supervisor
Dedra Harris

Your last job title

Reason for leaving (be specific)

Employment dates

Pay or salary

$7.25

From June 2012

Start

To

Final $8.00

present

Life gaurd

Seasonal

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.
As a life guard, I was required to do pre-work chores: sweep, clean sinks/toilets, set out supplies. During business hours I had to watch
swimmers closely and be alert incase of emergency. I was also a swim instruction to children. Post-work chores included re-cleaning the work
area. I have my certified life guard license which first aid and AED is included.

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? _______________________________________________________________________________________