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34 views

Application

Uploaded by

api-245582844
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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!

Employment Application
Name: Brockman Last Telephone: 651-237-1111 Address:
Brandon

COMPANY OR EMPLOYER NAME:


Position applying for:
Heavy Machinery Operator

EMPLOYEE INFORMATION
Jacob

First Email: [email protected]

Middle Alternate telephone: N/A

902 92nd street south

Are you able to perform the essential functions of the position with or without accommodations?
Yes 14 18 Yes No 15 19 No Yes No 16 21 (Check one)

If necessary for the job are you older than:

If necessary for the job, I am able to: Yes No Work overtime? Yes No Provide a valid Alaska Driver's License? Iowa If so, fill out the following: Issuing state: Class C Type: Endorsement(s):
Hazardous Material Tankers School Bus Any Split Day Night Other: Passengers Tank with Hazardous Materials Double/Triple trailers Swing Rotating

I am legally eligible for employment in the U.S.? I am seeking a permanent position:

Work the following shifts: (check all that apply)


Graveyard

I will be able to report to work 1 days after being notified I am hired.

EMPLOYMENT HISTORY
List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.

Nordic lanes Bowling ally, 1003 8th St. N, Northwood, IA Pay: $ 8.50 Per: Hour

Employer name and address:

Position title/duties, skills:

I took peoples orders, Cooked their food, Served their food, I would then clean up the tables and do all the dishes.
Supervisor: Position title/duties, skills: Telephone:

Sep, 2013

Start date:

End date:

Reason for leaving:

Current N/A

Diamond Jo Casino, 777 Diamond Jo Lane, Northwood, IA Pay: $ 9.07 Per: Hour

Employer name and address:

Start date:

End date:

Dishwasher, Carried heavy stacks of plates, Cleaned and stalked rooms.


Supervisor: Position title/duties, skills: Telephone:

June,2012

Reason for leaving:

Absence, misread work schedule.


Start date: End date:

City of Northwood, 627 Central Ave.

Employer name and address:

August Life Guard, Over watched the pool to insure that no June Reason for leaving: one was drowning. Seasonal Job.
Telephone: Start date:

Pay: $ 7.50 Per: Hour Employer name and address:

Supervisor: Position title/duties, skills:

End date:

Reason for leaving: Pay: Per: $ Supervisor: Telephone:


Employment Application Page 1 of 2

Rev. 8/2010

!
Summarize other employment related to this job:

EDUCATION
Institution name High school College/university Business/technical Additional
Northwood-Kensett

Years completed
4

Field of study

Graduate or degree

General

2014

MILITARY
Are you a veteran? Duty/specialized training: Yes

/ No
SKILLS & QUALIFICATIONS

N/A

Good welder, I have operated heavy machinery before.


N/A
Professional licenses, certifications or registrations:

Other qualifications such as special skills, abilities or honors that should be considered: Types of computers, software, and other equipment you are qualified to operate or repair:

N/A
Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employers attention: Typing speed:

N/A

N/A

per minute

REFERENCES
List two personal references who are not relatives or former supervisors.

Jen Costello
Name

689 4000th street


Address

900-900-9000
Telephone

Teacher
Occupation

9
Years known

Ranada Tenold
Name

111 111th street


Address

900-900-8999
Telephone

Insurance claim adjuster


Occupation

9
Years known

CONTACT In case of accident or illness, please contact: Name: Deb Brockman 999 Hulk Lane Address: INFORMATION TO THE APPLICANT

Daytime phone: Relationship:

888-888-7777 Mommy

As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references. If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above.

Signature of Applicant

Brandon Brockman

02/06/2014
Date

Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment. Developed at employer request by the Alaska Department of Labor & Workforce Development, Employment Security Division. Rev. 8/2010 Employment Application Page 2 of 2

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