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.
DATE ________________________________
Tyler
Ray
Jones
Name ______________________________________________________________________________________________
Last
First
Middle
Maiden
507
South Harrison St Lake Mills Iowa 50450
Present address ______________________________________________________________________________________
Number
Street
City
State
Zip
xxxx
xxx
xx _________
Social Security No. _______
_____
1 year
How long ____________________
Telephone (xxx-xxx-xxxx
)
If under 18, please list age _____________________
Days/hours available to work
X
X
No Pref _______
Thur ________
X
X
Mon __________
Fri __________
X
X
Tue __________
Sat _________
X
X
Wed _________
Sun ________
Cashier
Position applied for (1) ________________________
Negotiable
and salary desired (2) ________________________
(Be specific)
Less then 40 hours
Yes
How many hours can you work weekly? _________________________
Can you work nights? _______________________
Employment desired
X PART-TIME ONLY
__
__ FULL-TIME ONLY
__ FULL- OR PART-TIME
May 15, 2016
When available for work?_______________
____________________________________________________________________________________________________
TYPE OF SCHOOL
College
LOCATION
(Complete mailing
address)
Northwood-Kensett HS
704 7th St N
Northwood, IA 50459
NA
NA
Bus. or Trade School
NA
Professional School
NA
High School
NAME OF SCHOOL
NUMBER OF YEARS
COMPLETED
3.5 Years
MAJOR &
DEGREE
Diploma, May 2016
NA
NA
NA
NA
NA
NA
NA
NA
HAVE YOU EVER BEEN CONVICTED OF A CRIME?
X No
__
__ 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
__
Personal Vehichle
What is your means of transportation to work? _______________________________________________________________
Drivers license
Iowa
xxxxxxxx
number ____________________________
State of issue _______
xx-xx-xxxx
Expiration date ______________________
Have you had any accidents during the past three years?
Have you had any moving violations during the past three years?
X Operator __ Commercial (CDL)
__
__ Chauffeur
0
How many? ___________________
0
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.
Mrs. Renwick
Name _______________________________________
Mrs. Faugstad
Name _____________________________________________
K-12 Language Arts Chair
Position ______________________________________
7-12 English Teacher
Position ___________________________________________
High School
Company _____________________________________
High School
Company __________________________________________
704 7th St N
Address ______________________________________
704 7th St N
Address ___________________________________________
Northwood,
IA 50459
______________________________________
Northwood, IA 50459
___________________________________________
Telephone (xxx-xxx-xxxx
)
Telephone (xxx-xxx-xxxx
)
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.
I have a high math skill levels so I would be able to give change very easily. I have good
socials skills and like helping/talking to people especially when and if they need it.
I would like to think of myself as a good hard working citizen that does what is needed
and I dont just half do it. I completed it in full as much and as best as I can.
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?
__ Yes __ No
__ Yes __ No
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
NA
Name of last
supervisor
NA
Employment dates
From
To
NA
Pay or salary
Start
NA
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.
NA
Name of employer
Address
City, State, Zip Code
Phone number
Name of last
supervisor
NA
NA
Employment dates
From
To
NA
Pay or salary
Start
Final
NA
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.
NA
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
NA
Employment dates
From
NA
To
Pay or salary
Start
NA
Final
NA
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.
NA
Name of employer
Address
City, State, Zip Code
Phone number
Name of last
supervisor
NA
Employment dates
From
NA
To
Pay or salary
Start
NA
Final
NA
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.
NA
May we contact your present employer?
X No
__ Yes __
Did you complete this application yourself
X Yes __ No
__
If not, who did? _______________________________________________________________________________________
