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
Harris Conner Steven 02-13-2019
Street Address
Text Home Phone
( )
4589 Mallard AVE -
641-324-2-472
City, State, Zip
Northwood, Iowa, 50459
Business Phone Email Address:
( 641-381-0202
) -
What was your previous address? How long at present
previous
address?
NA
_________ Years
NA ________
NA 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?
18
_________ Years
________
1 Months
Have you ever applied for employment with us? Social Security No.
Yes No
NA
If Yes: Month and Year__________ NA
Location______________________________ - -
xxx-xx-xxxx
How did you learn of our organization?
Over the phone
Are you legally eligible for employment in the United States? When will you be able to work?
Yes When ever needed
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?
XXXXXXXXX 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
North Iowa Area Community Collage
AG 0 No NA
High Yes
Northwood Kensett Gen 4 No NA
Trade Yes
School NA NA NA No NA
Other Yes
NA NA NA No NA
Military
Complete this section if you served in the U.S. Armed Forces Branch of Service
NA NA
Describe your duties and any special training Period of Active Duty (Month & Year)
FromNA ToNA
Rank at DischargeNA
Date of Final Discharge
NA NA
Employment History Please give accurate, complete full-time and part-time employment
record. Start with present or most recent employer.
Company Name Telephone
Harris Farms ( ) -
Address Employed (Start Month and Year)
1321-1325 460th St From To
1.
Name of Supervisor Hourly Rate
Roger Harris Start Last
Start Job Title and Describe Your Work Reason for Leaving
Farm Hand Still employed
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Printable Job Application
Company Name Telephone
Thorson Cattle Company ( ) -
Address Employed (Start Month and Year)
From To
2.
Name of Supervisor Hourly Rate
Terri Thorson Start Last
Start Job Title and Describe Your Work Reason for Leaving
Cattle chores Temporary employment
Company Name Telephone
( ) -
Address Employed (Start Month and Year)
From To
3.
Name of Supervisor Hourly Rate
Start Last
Start Job Title and Describe Your Work Reason for Leaving
Company Name Telephone
( ) -
Address Employed (Start Month and Year)
From To
4.
Name of Supervisor Hourly Rate
Start Last
Start Job Title and Describe Your Work Reason for Leaving
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.
Mike Hanson NA Hanson Farms 5
2.
David Hengesteg NA Hengesteg Farms 7
3.
Darin Dahlby NA Dahlby Farms 7
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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.
___________________
02-13-2019 Conner Harris
_________________________________
Date Signature
Please complete and mail or fax a copy of this form to:
Environmental Recycling
Attn: Human Resources
PO Box 167, Bowling Green, Ohio 43402
Phone (419) 354-6110
Fax (419) 354-5110
http://www.envrecycle.com/
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