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. 2/4/17
DATE ________________________________
Boyden Chelsea R
Name ______________________________________________________________________________________________
Last First Middle Maiden
1002 8th Ave N Northwood IA 50459
Present address ______________________________________________________________________________________
Number Street City State Zip
7 months
How long ____________________ XXXX _____
Social Security No. _______ XX _________
XXXX
Telephone ( ) N/A
If under 18, please list age _____________________
Days/hours available to work
checker
Position applied for (1) ________________________ No Pref _______ Thur ________
negotiable
and salary desired (2) ________________________ 4-close
Mon __________ 4-close
Fri __________
(Be specific) 4-close 4-close
Tue __________ Sat _________
Wed _________ Sun ________
negotiable
How many hours can you work weekly? _________________________ Yes
Can you work nights? _______________________
Employment desired __ FULL-TIME ONLY X PART-TIME ONLY
__ __ FULL- OR PART-TIME
Immediately
When available for work?_______________
____________________________________________________________________________________________________
TYPE OF SCHOOL NAME OF SCHOOL LOCATION NUMBER OF YEARS MAJOR &
(Complete mailing COMPLETED DEGREE
address)
High School Northwood-Kensett 3.5 Diploma
Jr./Sr. High School
College NIACC 1 N/A
Bus. or Trade School
Professional School
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
__
What is your means of transportation to work? _______________________________________________________________
Drivers license
number ____________________________
XXXXXXXXXXXXX Iowa
State of issue _______ X Operator __ Commercial (CDL)
__ __ Chauffeur
X/XX/XX
Expiration date ______________________
Have you had any accidents during the past three years? 0
How many? ___________________
Have you had any moving violations during the past three years? 0
How Many? ___________________
OFFICE ONLY
__ Yes __ Yes Word __ Yes
Typing __ No _____ WPM 10-key __ No Processing __ No _____ WPM
Personal __ Yes __ PC Other _____________________________________________
Computer __ No __ Mac Skills ______________________________________________
Please list two references other than relatives or previous employers.
Jill Kofron
Name _______________________________________ Timothy Marx
Name _____________________________________________
Iowa FCCLA Leadership Coordinator
Position ______________________________________ Iowa FCCLA Executive Director
Position ___________________________________________
Iowa FCCLA Association
Company _____________________________________ Company Iowa FCCLA Association
__________________________________________
Address ______________________________________ Address ___________________________________________
______________________________________ ___________________________________________
Telephone ( ) N/A Telephone ( ) N/A
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 am passionate about serving people and my ability communicating with others is something I pride myself in.
Communicating with people isnt difficult for me because of all of the experience I have had at other jobs with
people as well as my experiences in co-curricular activities at school.
PLEASE PRINT ALL
INFORMATION REQUESTED
EXCEPT SIGNATURE
APPLICATION FOR EMPLOYMENT
MILITARY
HAVE YOU EVER BEEN IN THE ARMED FORCES? X No
__ Yes __
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD? X No
__ Yes __
N/A
Specialty ___________________________________ N/A
Date Entered ________________ N/A
Discharge Date ______________
Work Please list your work experience for the past five years beginning with your most recent job held.
Experience If you were self-employed, give firm name. Attach additional sheets if necessary.
Name of employer Name of last Employment dates Pay or salary
Address Kitchen Buffet at Diamond Jo Casino supervisor
City, State, Zip Code
From 10/15 Start $9.50
Phone number Davis
Kitchen Buffet at Diamond Jo Casino To 6/16 Final $9.50
Your last job title Host
Reason for leaving (be specific) Left to concentrate on school
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.
Host- Cash register skills, communication skills, ability to lift heavy boxes
Name of employer Name of last Employment dates Pay or salary
Address NSB Bank supervisor
City, State, Zip Code Fox From 6/14 Start $7.25
Phone number
To 10/15 Final $7.25
Your Last Job Title Teller
Reason for leaving (be specific) New job
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.
Teller- counting money, using advanced software, communication skills
PLEASE PRINT ALL
INFORMATION REQUESTED
EXCEPT SIGNATURE
APPLICATION FOR EMPLOYMENT
Work Please list your work experience for the past five years beginning with your most recent job held.
experience If you were self-employed, give firm name. Attach additional sheets if necessary.
Name of employer Name of last Employment dates Pay or salary
Address supervisor
City, State, Zip Code
From Start
Phone number
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 Name of last Employment dates Pay or salary
Address supervisor
City, State, Zip Code
Phone number 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? _______________________________________________________________________________________
