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.
Sletten
DATE ________________________________
Paije
Annmarie
Name ______________________________________________________________________________________________
Last
First
Middle
Maiden
208
5th St. N
50459
Northwood Iowa
Present address ______________________________________________________________________________________
Number
Street
10 years
How long ____________________
Telephone (
City
State
Zip
Social Security No. _______ _____ _________
If under 18, please list age _____________________
Days/hours available to work
X
No Pref _______
Thur ________
Mon __________ Fri __________
Tue __________ Sat _________
Wed _________ Sun ________
Server
Position applied for (1) ________________________
$4.50
and salary desired (2) ________________________
(Be specific)
15 hours
I can only work nights
How many hours can you work weekly? _________________________ Can you work nights? _______________________
Employment desired
X PART-TIME ONLY
__
__ FULL-TIME ONLY
__ FULL- OR PART-TIME
When available for work?_______________
Afternoon or nights
____________________________________________________________________________________________________
TYPE OF SCHOOL
High School
College
NAME OF SCHOOL
Northwood-Kensett
Jr./Sr. High School
NIACC
LOCATION
(Complete mailing
address)
704 7th St. N
Northwood, IA 50459
500 College Drive
NUMBER OF YEARS
COMPLETED
MAJOR &
DEGREE
3.5
Diploma, May 2016
Online/Partime, 2
N/A
Mason City, IA 50401
Bus. or Trade School
Professional School
HAVE YOU EVER BEEN CONVICTED OF A CRIME?
__ No
X 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
I drive my car
What is your means of transportation to work? _______________________________________________________________
Drivers license
Iowa
number ____________________________ State of issue _______
September 2021
Expiration date ______________________
N/A
Have you had any accidents during the past three years?
Have you had any moving violations during the past three years?
Yes
X Operator __ Commercial (CDL)
__
How many?
How Many?
__ Chauffeur
N/A
___________________
1
___________________
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.
Morgan Johnson
Name _______________________________________
Sue Bestul
Name _____________________________________________
Librarian
Position ______________________________________
Spanish Teacher
Position ___________________________________________
Northwood-Kensett School District
Company _____________________________________
Northwood- Kensett School District
Company __________________________________________
704 7th St. N
Address ______________________________________
704 7th St. N
Address ___________________________________________
Northwood, Iowa 50459
______________________________________
Northwood, IA 50459
___________________________________________
Telephone ( 641-324-2142
)
Telephone ( 641-324-2142
)
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?
X No
__ Yes __
__ Yes X
__ No
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?
N/A
N/A
N/A
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 Country Inn and Suites
Address 711 Diamon Jo Ln
City, State, Zip Code Northwood, Iowa 50459
Phone number 641-324-7067
Name of last
supervisor
Pamela Elliot
Employment dates
From
December
2014
To February 2015
Your last job title
Reason for leaving (be specific)
Pay or salary
Start
$8.50
Final $8.50
Housekeeper
New Career Option
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.
Making beds, cleaning bathrooms, vacuuming, dusting, organizing
Name of employer
Address
City, State, Zip Code
Phone number
Name of last
supervisor
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
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
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?
X Yes __ No
__
Did you complete this application yourself
X Yes __ No
__
If not, who did? _______________________________________________________________________________________
