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Employment Application
Name:
Benson
COMPANY OR EMPLOYER NAME:
Vermillion High School
Position applying for:
Middle School Teacher
EMPLOYEE INFORMATION
Logan Jesse Wallock
Last Telephone: 641-430-5390 Address:
First Email: 14lbenson@nkstudents.com
Middle Alternate telephone: N/A
805 11th St. N. Northwood Iowa, 50459
Are you able to perform the essential functions of the position with or without accommodations?
Yes 14 18 Yes No 15 19 No Yes No 16 21 (Check one)
If necessary for the job are you older than:
If necessary for the job, I am able to: Yes Work overtime? Yes Provide a valid Alaska Driver's License? If so, fill out the following: Issuing state: Class C Type: Endorsement(s):
Hazardous Material Tankers School Bus Any Split Day Night Other:
No No
Passengers
I am legally eligible for employment in the U.S.? I am seeking a permanent position:
Tank with Hazardous Materials Double/Triple trailers Swing Rotating
Work the following shifts: (check all that apply)
Graveyard
I will be able to report to work Open days after being notified I am hired.
EMPLOYMENT HISTORY
List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.
Employer name and address:
Benson Lawn Care 805 11th St. N. Northwood IA , 50459 Pay: $ 7.50
Position title/duties, skills:
Mowing
Start date:
06/10
End date:
09/13
Reason for leaving:
Per: Hour Employer name and address:
Supervisor: Position title/duties, skills:
Telephone: 641-430-7986 Start date: End date:
Reason for leaving: Pay: $ Per: Employer name and address:
Supervisor: Position title/duties, skills:
Telephone: Start date: End date:
Reason for leaving: Pay: $ Per: Employer name and address:
Supervisor: Position title/duties, skills:
Telephone: Start date: End date:
Reason for leaving: Pay: Per: $ Supervisor: Telephone:
Employment Application Page 1 of 2
Rev. 8/2010
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Summarize other employment related to this job:
EDUCATION
Institution name High school College/university Business/technical Additional
Northwood-Kensett N/A N/A N/A
Years completed
6 N/A N/A N/A General N/A N/A N/A
Field of study
Graduate or degree
Diploma-2014 N/A N/A N/A
MILITARY
Are you a veteran? Duty/specialized training: Yes
N/A
No
SKILLS & QUALIFICATIONS
Other qualifications such as special skills, abilities or honors that should be considered:
President of 4-H Club
Types of computers, software, and other equipment you are qualified to operate or repair:
Simple Computer
Professional licenses, certifications or registrations:
N/A
Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employers attention:
N/A
Typing speed:
56
per minute
REFERENCES
List two personal references who are not relatives or former supervisors.
Deb Nagle 966 8th Ave N. Address 677 8th Ave. N 555-555-5555 Telephone 555-555-5556 Teacher Occupation Teacher Occupation 12
Name
Morgan Johnson
Years known
4
Name
Address
Telephone
Years known
CONTACT
In case of accident or illness, please contact: Name: Susan 805 11th St. N. Address: Daytime phone: 641-430-0304 Relationship: Mother
INFORMATION TO THE APPLICANT
As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references. If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above. Logan Benson 02/4/14
Signature of Applicant
Date
Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment. Developed at employer request by the Alaska Department of Labor & Workforce Development, Employment Security Division. Rev. 8/2010 Employment Application Page 2 of 2
