Sample Employment Application Form

PLEASE PRINT ALL

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

PLEASE COMPLETE PAGES 1-4.

DATE ________________________________

Tyler
Ray
Jones
Name ______________________________________________________________________________________________
Last

First

Middle

Maiden

507
South Harrison St Lake Mills Iowa 50450
Present address ______________________________________________________________________________________
Number

Street

City

State

Zip

xxxx
xxx
xx _________
Social Security No. _______
_____

1 year
How long ____________________
Telephone (xxx-xxx-xxxx
)
If under 18, please list age _____________________

Days/hours available to work

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

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

Less then 40 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

May 15, 2016

When available for work?_______________
____________________________________________________________________________________________________

TYPE OF SCHOOL

College

LOCATION
(Complete mailing
address)
Northwood-Kensett HS
704 7th St N
Northwood, IA 50459
NA
NA

Bus. or Trade School

NA

Professional School

NA

High School

NAME OF SCHOOL

NUMBER OF YEARS
COMPLETED
3.5 Years

MAJOR &
DEGREE
Diploma, May 2016

NA

NA

NA

NA

NA

NA

NA

NA

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 Vehichle
What is your means of transportation to work? _______________________________________________________________
Drivers license
Iowa
xxxxxxxx
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)

__

__ Chauffeur

0
How many? ___________________
0
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.

Mrs. Renwick
Name _______________________________________

Mrs. Faugstad
Name _____________________________________________

K-12 Language Arts Chair

Position ______________________________________

7-12 English Teacher

Position ___________________________________________

High School
Company _____________________________________

High School
Company __________________________________________

704 7th St N
Address ______________________________________

704 7th St N
Address ___________________________________________

Northwood,
IA 50459
______________________________________

Northwood, IA 50459
___________________________________________

Telephone (xxx-xxx-xxxx
)

Telephone (xxx-xxx-xxxx
)

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 have a high math skill levels so I would be able to give change very easily. I have good
socials skills and like helping/talking to people especially when and if they need it.
I would like to think of myself as a good hard working citizen that does what is needed
and I dont just half do it. I completed it in full as much and as best as I can.

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?

__ Yes __ No
__ Yes __ No

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
Address
City, State, Zip Code
Phone number

NA

Name of last
supervisor

NA

Employment dates
From
To

NA

Pay or salary
Start

NA

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.

NA

Name of employer
Address
City, State, Zip Code
Phone number

Name of last
supervisor

NA
NA

Employment dates
From
To

NA

Pay or salary
Start
Final

NA

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.

NA

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

NA

Employment dates
From

NA

To

Pay or salary
Start

NA

Final

NA

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.

NA

Name of employer
Address
City, State, Zip Code
Phone number

Name of last
supervisor

NA

Employment dates
From

NA

To

Pay or salary
Start

NA

Final

NA

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.

NA

May we contact your present employer?

X No
__ Yes __

Did you complete this application yourself

X Yes __ No
__

If not, who did? _______________________________________________________________________________________