Sample Employment Application Form

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE
APPLICATION FOR EMPLOYMENT
APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

January 15th, 2016

PLEASE COMPLETE PAGES 1-4.

DATE ________________________________

Julson
Hunter
Donald
Name ______________________________________________________________________________________________
Last

Present address

First

Middle

Number

Street

City

5 years
How long ____________________
Telephone (

Maiden

107 2nd ave S

Northwood Iowa 50459
______________________________________________________________________________________
State

Zip

Social Security No. _______ _____ _________

17
If under 18, please list age _____________________
Days/hours available to work
x Thur ________
No Pref _______
Mon __________ Fri __________
Tue __________ Sat _________
Wed _________ Sun ________

Agri Sales
Position applied for (1) ________________________
and salary desired (2) ________________________
$11/Hour
(Be specific)
As many as I need to

Prefer not to but can

How many hours can you work weekly? _________________________ Can you work nights? _______________________
Employment desired

__ FULL-TIME ONLY

__ PART-TIME ONLY

__ FULL- OR PART-TIME

As soon as possible

When available for work?_______________

____________________________________________________________________________________________________

TYPE OF SCHOOL

High School
College

NAME OF SCHOOL

Northwood Kensett
NIACC

LOCATION
(Complete mailing
address)

704 7th street N

NUMBER OF YEARS
COMPLETED

3.5 years

MAJOR &
DEGREE

Diploma, May 15th

Northwood, IA
500 college drive

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

Drives
What is your means of transportation to work? _______________________________________________________________
Drivers license
number ____________________________ State of issue _______
Expiration date ______________________

__ Operator __ Commercial (CDL)

__ Chauffeur

NO

Have you had any accidents during the past three years?
Have you had any moving violations during the past three years?

How many? ___________________

NO
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.

Deb Faugstad
Name _______________________________________
K-12 Language Arts Chair 7-12 Eng teacher

Position ______________________________________

NA

Company _____________________________________

704 7th Street N

Amy Renwick
Name _____________________________________________
Guidance Conselor
Position ___________________________________________
NK Schools
Company __________________________________________

Address ______________________________________

704 7th St N
Address ___________________________________________

______________________________________

___________________________________________

Telephone (

Telephone (

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.

Grown up with Ag almost my entire life.

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?

x No
__ Yes __
x No
__ Yes __

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 Hogen Lawn Care

Address 308 10th street S
City, State, Zip Code Northwood, Iowa, 50459
Phone number

Name of last
supervisor

Paul Hogen

Employment dates

Pay or salary

From May, 2014

Start $9.00

To July, 2014

Final $10.00

Your last job title

Reason for leaving (be specific)

Football was starting and needed to focus more on that, during the summer

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

Lawn mover, hedge trimming, weed eating, trimming.

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?

__ Yes __ No

Did you complete this application yourself

x No
__ Yes __

If not, who did? _______________________________________________________________________________________