Sample Employment Application Form

PLEASE PRINT ALL

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

1/7/15
DATE ________________________________

PLEASE COMPLETE PAGES 1-4.

Creger
Aliyah
Paige
Name ______________________________________________________________________________________________
Last

First

Middle

Maiden

115

Osage
50461
Kirkwood Ave.
IA
Present address ______________________________________________________________________________________
Number

Street

6 months
How long ____________________

Telephone (

City

State

Zip

Social Security No. _______

_____
_________
XXXX
XX
XXX

) N/A

17
If under 18, please list age _____________________

Days/hours available to work

X
No Pref _______
Thur ________
Mon __________ Fri __________
Tue __________ Sat _________
Wed _________ Sun ________

Lifeguard
Position applied for (1) ________________________
$7.50/hour
and salary desired (2) ________________________
(Be specific)

Yes
15-20 hours
How many hours can you work weekly? _________________________
Can you work nights? _______________________

Employment desired

__ FULL-TIME ONLY

__ PART-TIME ONLY

X FULL- OR PART-TIME
__

Immediately
When available for work?_______________

____________________________________________________________________________________________________

TYPE OF SCHOOL

NAME OF SCHOOL

High School

Northwood-Kensett

College

North Iowa Area Community

College

Bus. or Trade School

N/A

Professional School

N/A

LOCATION
(Complete mailing
address)

NUMBER OF YEARS
COMPLETED

704 7th Street North, Northwood, 3.5

IA, 50459

Diploma - May, 2016

500 College Drive, Mason City, 1.5

IA, 50401

HAVE YOU EVER BEEN CONVICTED OF A CRIME?

X No
__

MAJOR &
DEGREE

N/A

__ 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
__

I will drive my car to work.

What is your means of transportation to work? _______________________________________________________________

Drivers license
number ____________________________ State of issue _______
Expiration date ______________________

__
X Operator __ Commercial (CDL)

__ Chauffeur

1
How many? ___________________
0
How Many? ___________________

Have you had any accidents during the past three years?
Have you had any moving violations during the past three years?
OFFICE ONLY
__ Yes
__ No

Typing

_____ WPM

__ Yes
10-key __ No

Word
Processing

__ Yes
__ No

_____ WPM

Text

Personal
Computer

__ Yes
__ No

__ PC
__ Mac

Other _____________________________________________
Skills ______________________________________________

Please list two references other than relatives or previous employers.

Beth Butler
Name _______________________________________

Amy Renwick
Name _____________________________________________

Teacher
Position ______________________________________

Guidance Counselor
Position ___________________________________________

Northwood-Kensett Community School District

Company _____________________________________

Northwood-Kensett Community School District

Company __________________________________________

704 7th Street North, Northwood, IA, 50459

Address ______________________________________

704 7th Street North, Northwood, IA, 50459

Address ___________________________________________

______________________________________

___________________________________________

Telephone ( 641-324-1127
)

Telephone ( 641-324-1127
)

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 __

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 Avenue
City, State, Zip Code : Northwood, IA, 50459
Phone number : 641-324-1075

Name of last
supervisor
Susan Kliment

Employment dates

Pay or salary

From : May, 2014

Start $7.25

To : 2016 summer

Final $7.50

Your last job title : Lifeguard

Reason for leaving (be specific) : N/A
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.
Lifeguard:
- cleaning
- swimming lessons
- making sure kids were
safe while swimming

Name of employer N/A

Address
City, State, Zip Code
Phone number

Skills I used/learned:
- patience
- compassion
- alertness
- ability to work with
many different people
- leadership

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

N/A

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 N/A

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
__

N/A
If not, who did? _______________________________________________________________________________________