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.

DR
Lafferty
Jaden
Name ______________________________________________________________________________________________
Last

Present address

First

Middle

1418

500th st.

Number

Street

City

State

Zip

xx
xxx
xxxx
Social Security No. _______
_____
_________

7 years
How long ____________________

Telephone (

Maiden

Northwood
Iowa
50459
______________________________________________________________________________________

641 ) 381-0040

17 years old
If under 18, please list age _____________________

Days/hours available to work

4pm-12am
No Pref _______ Thur ________
4pm-12am
4pm-12am
Mon __________
Fri __________
All open hours
4pm-12am
Tue __________
Sat _________
All open hours
4pm-12am
Wed _________
Sun ________

Cashier
Position applied for (1) ________________________
$9.75
/ negotiable
and salary desired (2) ________________________
(Be specific)

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

Employment desired

x PART-TIME ONLY
__

__ FULL-TIME ONLY

__ FULL- OR PART-TIME

ASAP
When available for work?_______________

____________________________________________________________________________________________________

TYPE OF SCHOOL

High School

NAME OF SCHOOL

Northwood-Kensett

Junior Senior Highschool

College

NIACC

LOCATION
(Complete mailing
address)
704 7th st. N

NUMBER OF YEARS
COMPLETED

MAJOR &
DEGREE

3.5

Diploma May, 2016

1.5

PSEO

Northwood, IA 50459
500 College Dr.

Mason City, Iowa 50401

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
N/A
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
__

Family Vehicle
What is your means of transportation to work? _______________________________________________________________

Drivers license
Iowa
xxxxxxxxxxxxxx
number ____________________________
State of issue _______
02/16
Expiration date ______________________

x Operator __ Commercial (CDL)

__

__ Chauffeur

N/A
How many? ___________________
How Many? ___________________
N/A

Have you had any accidents during the past three years?
Have you had any moving violations during the past three years?
OFFICE ONLY

Typing

x Yes
__
__ No

Personal
Computer

x Yes
__
__ No

100
_____
WPM

__ Yes
x No
10-key __

x PC
__
x Mac
__

Word
Processing

x Yes
__
__ No

100
_____
WPM

N/A
Other _____________________________________________
Skills ______________________________________________

Please list two references other than relatives or previous employers.

Name _______________________________________

Name _____________________________________________

Position ______________________________________

Position ___________________________________________

Company _____________________________________

Company __________________________________________

Address ______________________________________

Address ___________________________________________

______________________________________

___________________________________________

Telephone (

Telephone (

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.
I am able to count and handle large amounts of money. I can deal with problematic customers.

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 No
__ Yes __

N/A
N/A
N/A
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 Northwood Lutheran Retirement Home

Address 701 9th St N,
City, State, Zip Code Northwood, Iowa 50459
Phone number (641)-324-1712

Name of last
supervisor
Nancy Friderk

Your last job title

Reason for leaving (be specific)

Employment dates

Pay or salary

From

June 2014

Start

$9.00

To

July 2014

Final

$9.00

Kitchen Aid

Found different emplyment

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.
Worked with the elderly, worked around food.

Name of employer Caseys General Store

Address
City, State, Zip Code Northwood, Iowa 50459
Phone number (641)-324-0643

Name of last
supervisor
Julie Harris

Employment dates
From
To

Your Last Job Title

Reason for leaving (be specific)

Pay or salary

July 2nd

Start

$8.25

Current

Final

$9.75

Cashier

Still Employed

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.
Jobs Held: Cashier
Duties Performed: Stocking products, handling money, closing the store, cleaning and washing clothes.
Skills Used or Learned: Running a cash register, stocking inventory, counting a safe, handling concerns of customers, taking food orders.
Advancements or Promotions: No Advancements or Promotions available

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
__

N/A
If not, who did? _______________________________________________________________________________________