Printable Job Application

Application for Employment

Please fill out form completely for employment consideration. Print and fax or mail when
completed.

Prospective employees will receive consideration without discrimination because of race, creed,
color, sex, age, national origin or handicap. We are an equal opportunity employer.
Personal Information
Last Name First Middle Date
Hanson Jason James Jan, 13, 2021

Street Address Home Phone

1307 3rd Ave South ( 641 ) 210-XXXX

-
City, State, Zip
Northwood, Iowa, 50459

Business Phone Email Address:

( ) - N/A
22jhanson@nkstudents.com

What was your previous address? How long at present

address?

N/A
17 years
_________ Years
________
11 1/2 Months
Are you over 18 years of age? Yes 0 No How long at present
If not, employment is subject to verification of minimum legal age. address?
N/A
_________ Years
________
N/A Months
Have you ever applied for employment with us? Social Security No.
Yes No
N/A N/A 484 - 33 -XXXX
If Yes: Month and Year__________ Location______________________________

How did you learn of our organization?

I learned of this job from my friends.

Are you legally eligible for employment in the United States? When will you be able to work?
Yes
After the basketball season

Are you employed now? If so, may we inquire of your present employer?
No
N/A

Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary
offenses, which has not been annulled, expunged or sealed by a court? Yes No If
Yes, describe in full.
Printable Job Application

Are there any reasons for which you might not be able to perform the job duties (with a
reasonable accommodation)?
Yes No If Yes, please explain.

Drivers License# State Any Violations?

XXXX44XXXXX Iowa
Yes No

Education

No. of
Course of Did you Degree or
School Name and location of school years
study graduate? diploma
completed
College North Iowa Area Community College
Human Relations Yes
/Euntrepenurship
No
High Northwood-Kensett Jr/Sr Highschool Highschool 12.5
Yes Highschool
Diploma
No
Trade Yes
School No
Other Yes
No

Military
Complete this section if you served in the U.S. Armed Forces Branch of Service

N/A

Describe your duties and any special training Period of Active Duty (Month & Year)

From To
Rank at Discharge
Date of Final Discharge

Employment History Please give accurate, complete full-time and part-time employment
record. Start with present or most recent employer.

Company Name Telephone

Strike Zone
( 320 ) 552. - 0461

Address Employed (Start Month and Year)

1003 Eight St N
From Dec. 2019 To June. 2021
1.
Name of Supervisor Hourly Rate
Matt Grunzke
Start $10 Last $10

Start Job Title and Describe Your Work Reason for Leaving
Line Cook. Made grill/fryer food, and
Bad scheduling, payment issuses
pizzas. Also did ball calls and cleaning.

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Printable Job Application

Company Name Telephone

Northwood Public Swimming Pool ( 641 ) 324 - 1680
Address Employed (Start Month and Year)
627 Central Ave Northwood, Ia
From Summer 2018 To Summer 2021
2.
Name of Supervisor Hourly Rate
Kristie Parks
Start $9 Last $9.50

Start Job Title and Describe Your Work Reason for Leaving
Lifeguard. Watch people swim, make sure they do not drown. Some other duties to
Summer ended
open and close.
Company Name Telephone
( ) -
Address Employed (Start Month and Year)

From To
3.
Name of Supervisor Hourly Rate

Start Last
Start Job Title and Describe Your Work Reason for Leaving

Company Name Telephone

( ) -
Address Employed (Start Month and Year)

From To
4.
Name of Supervisor Hourly Rate

Start Last
Start Job Title and Describe Your Work Reason for Leaving

Do not contact
We may contact the employers listed above
unless you indicate those you do not want us to Employer Number(s)_____________________
contact. Reason____________________________

References: Give below the names of three persons not related to you, whom you have known at
least one year.
Years
Name Address Business
Acquainted
1. Kriste Parks 123 Playground Stret. Northwood Pool 2

2.
Dan Block 123 Playground Stret.

3.
Tyler “Ninja” Blevins 123 Playground Stret.

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Printable Job Application

The information provided in this Application for Employment is true, correct and complete. If
employed, any misstatements or omissions of fact on this application may result in my dismissal.
I understand that acceptance of an offer of employment does not create a contractual obligation
upon the employer to continue to employ me in the future.
If you decide to engage an investigative consumer reporting agency to report on my credit and
personal history, I authorize you to do so.
If a report is obtained you must provide, at my request, the name and address of the agency so I
may obtain from them the nature and substance of the information contained in the report.

January 17, 2021

___________________ _________________________________
Date Signature

Please
Please complete
complete andand mail
mail or fax
or drop thisaform
copy
to: of this form to:
Environmental Recycling
Waveland Golf Course
Attn: Human Resources
Attn: Rocky Sposato
PO Box 167, Bowling Green, Ohio 43402
4908 University Ave
Phone (419) 354-6110
Des Moines, IA 50311
Fax (419) 354-5110
Email to: http://www.envrecycle.com/
wavelandgolf@yahoo.com

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