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 ________________________________

1/31/17

Stubbe Jade Arianna

Name ______________________________________________________________________________________________
Last First Middle Maiden

1408 1st Ave South Northwood, IA, 50459

Present address ______________________________________________________________________________________
Number Street City State Zip

6 years
How long ____________________ xxx _____
Social Security No. _______ xx _________
xxx
Telephone ( 641 ) 390-xxxx

If under 18, please list age _____________________

17

Days/hours available to work

Position applied for (1) ________________________
Cahier Nights
No Pref _______ Thur ________
and salary desired (2) ________________________
$8.75 Mon __________
Nights Fri __________
Nights
(Be specific) Tue __________
Nights Sat _________
Any/All
Wed _________
Nights Sun ________
Any/All

20-25
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
Two weeks after highering
When available for work?_______________

____________________________________________________________________________________________________

TYPE OF SCHOOL NAME OF SCHOOL LOCATION NUMBER OF YEARS MAJOR &

(Complete mailing COMPLETED DEGREE
address)
High School Northwood-Kensett Jr.-Sr. High 704 7th Street N. 3.5 HS Diploma
Northwood, IA 50459
College NIACC 500 College Drive 1.5 N/A
Mason City, IA 50401
Bus. or Trade School N/A N/A N/A N/A

Professional School N/A N/A N/A N/A

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 Vehicle
What is your means of transportation to work? _______________________________________________________________

Drivers license
number ____________________________
XXXXXXXXXXXXXXX IA
State of issue _______ __ Operator __
X Commercial (CDL) __ Chauffeur
07/08/2017
Expiration date ______________________

Have you had any accidents during the past three years? 1
How many? ___________________
Have you had any moving violations during the past three years? How Many? ___________________
0

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.

Name _______________________________________
Jake Gentz Name _____________________________________________
Courtney OByrne

Position ______________________________________
Farmer Security
Position ___________________________________________
Gentz Labs
Company _____________________________________ Diamond Jo Casino Worth
Company __________________________________________

Address ______________________________________
5050 Partridge Ave Northwood IA, 50459 Address ___________________________________________
777 Diamond Jo Lane Northwood IA, 50459

______________________________________ ___________________________________________

Telephone ( 641 ) 425-9033 Telephone ( 507 ) 402-5138

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 work well with others and I am very dependable.

 PLEASE PRINT ALL
INFORMATION REQUESTED
EXCEPT SIGNATURE
APPLICATION FOR EMPLOYMENT

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES? __ Yes __

X No

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD? __ Yes __

X No

Specialty ___________________________________ Date Entered ________________ 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 Diamond Jo Casino Worth Name of last Employment dates Pay or salary
Address 777 Diamond Jo Lane supervisor
City, State, Zip Code Northwood IA, 50459
From March 2016 Start $9.10
Phone number
To December 2016 Final $9.50

Your last job title Host

Reason for leaving (be specific) Better paying job.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.

Name of employer Target Name of last Employment dates Pay or salary

Address supervisor
City, State, Zip Code
From November 2015 Start $10
Phone number
$1
To March 2016 Final 0 $1
0
Your Last Job Title Cashier

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 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? _______________________________________________________________________________________