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
Hill Rachel Ann 1/13/2022
Street Address Home Phone
( )
1127 Hwy 105
-
641-324-5386
City, State, Zip

Northwood, IA 50459
Business Phone Email Address:
( ) 641-390-0756
- rachelann2h@gmail.com
What was your previous address? How long at present
address?
1239 4th St.
Northwood, IA 50459 10 Years
_________
3 Months
________
Are you over 18 years of age? Yes No How long at present
If not, employment is subject to verification of minimum legal age. address?
17 Years
_________
17 1 Months
________
Have you ever applied for employment with us? Social Security No.
Yes No
If Yes: Month and Year__________ Location______________________________ -
123456979 -

How did you learn of our organization?

My friend is currently working at your organization.

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

No.
April 1st, 2022.

Are you employed now? If so, may we inquire of your present employer?
Yes. Yes.
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?

12345 IA Yes No

Education

No. of
Course of Did you Degree or
School Name and location of school years
study graduate? diploma
completed
College Yes
No
High Yes
Northwood-Kensett High School High School 4 No 2022
Trade Yes
School No
Other Yes
No

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

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

Northwood Pool ( ) -
641-981-2456
Address Employed (Start Month and Year)
Northwood, IA Community Pool
From June 1st To August 14th
1.
Name of Supervisor Hourly Rate

Kristy Parks Start $8 Last $8

Start Job Title and Describe Your Work Reason for Leaving
Lifeguard End of Summer

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Printable Job Application

Company Name Telephone

Tequilas Mexican Bar & Grill ( ) -
641-323-0000
Address Employed (Start Month and Year)
846 Central Ave
June 1st 2020-October 29th 2021
Northwood, IA 50459 From To
2.
Name of Supervisor Hourly Rate
Shawna Ramirez Start $9 Last $9
Start Job Title and Describe Your Work Reason for Leaving
Server Helper Found a higher paying job
Company Name Telephone
R80 ( ) -
641-323-7555
Address Employed (Start Month and Year)
912 Central Ave, Northwood, IA 50459
From August 8th To
3.
Name of Supervisor Hourly Rate

Start $11 Last

Start Job Title and Describe Your Work Reason for Leaving
Cashier Haven’t left yet
Company Name Telephone
Bean & Bistro ( ) -
641-323-7139
Address Employed (Start Month and Year)
826 Central Ave,
Northwood, IA 50459 From November 1st To
4.
Name of Supervisor Hourly Rate
Jennifer Lombard Start $6 Last N/A
Start Job Title and Describe Your Work Reason for Leaving
Barista N/A
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.
Jennifer Lombard 826 Central Ave, Northwood IA 50459 Bean & Bistro 1 Year
2.
Shawna Ramirez 846 Central Ave, Northwood, IA 50459 Tequilas 2 Years
3.
Manuel Ramirez 846 Central Ave, Northwood, IA 50459 Tequilas 2 Years

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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.

1/17/2022
___________________ _________________________________
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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