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.

shafer

DATE ________________________________

john lyle

kenathan

n/a
Name ______________________________________________________________________________________________
Last

First

Middle

Maiden

506
2nd ave Nth northwood IA. 50459
Present address ______________________________________________________________________________________
Number

Street

City

State

Zip

xxxx
xx
xxx
Social Security No. _______
_____
_________

Text
How long ____________________
Telephone (641) 323-0092

17
If under 18, please list age _____________________
Days/hours available to work
yes
No Pref _______
Thur ________

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

Mon __________ Fri __________

Tue __________ Sat _________
Wed _________ Sun ________

20
no
How many hours can you work weekly? _________________________
Can you work nights? _______________________
Employment desired

yes
__ PART-TIME ONLY

__ FULL-TIME ONLY

__ FULL- OR PART-TIME

any time
When available for work?_______________
____________________________________________________________________________________________________

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION
(Complete mailing
address)

College

northwood kensett high 704 7th St. N

Northwood, IA 50459
mason city
NIACC

Bus. or Trade School

n/a

Professional School

n/a

High School

HAVE YOU EVER BEEN CONVICTED OF A CRIME?

__ No

NUMBER OF YEARS
COMPLETED

MAJOR &
DEGREE

3.5

Diploma, May 2016

1/2

Diesel Technician

yep
__ Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were
Three years ago I had a third degree sexual misconduct in Grandby,
committed, sentence(s) imposed, and type(s) of rehabilitation. __________________________________________________
Missouri

____________________________________________________________________________________________________

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE
APPLICATION FOR EMPLOYMENT

DO YOU HAVE A DRIVERS LICENSE?

X No
__ Yes __

Family member drive me, or ride bicycle or walk

What is your means of transportation to work? _______________________________________________________________

Drivers license
number ____________________________ State of issue _______
Expiration date ______________________

__ Operator __ Commercial (CDL)

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

__ Chauffeur

How many? ___________________

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.

Mr. Michael Reindl
Name _______________________________________

Denny Salz
Name _____________________________________________

Teacher
Position ______________________________________

Diesel Tech Instructor

Position ___________________________________________

Northwood-Kensett Comm. Schools

Company _____________________________________

NIACC
Company __________________________________________

704 7th St. N

Address ______________________________________

Address ___________________________________________

______________________________________

___________________________________________

Telephone (

) 324-2142

Telephone (

) 422-4190

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
Address
City, State, Zip Code
Phone number

Grandpas Apple Orchard

3762 Doherty Rd
Rio, WI 53960

Name of last
supervisor

Pay or salary

From Summer 2013 Start

Josh Billman

Your last job title

Reason for leaving (be specific)

Employment dates

To

Summer 2014

min. wage

Final

Farm Hand

Moved

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.
Stacked Hay, Cut down trees and turned them into firewood

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.

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
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.

May we contact your present employer?

__ Yes __ No

Did you complete this application yourself

__ Yes X__ No

N/A

Ms. Renwick helped me.

If not, who did? _______________________________________________________________________________________