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67 views

Application Form

Uploaded by

api-247126655
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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!

Employment Application
Name:

COMPANY OR EMPLOYER NAME:


Borgia's Big Bangs

Position applying for:

Firework Making

EMPLOYEE INFORMATION Costello Zachary


First Email: [email protected]

Joseph
Middle Alternate telephone: 641-390-0000

Last Telephone: 641-324-0000 Address:

425 Superhero Way, Northwood, IA 50459

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? If so, fill out the following: Issuing state: Iowa Type: Class C 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 2 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.

Employer name and address:


Northwood-Kensett Schools 1200 1st Ave. N Northwood, IA 50459 Pay: $ 7.25

Position title/duties, skills:

Start date:

End date:

Per: hour Employer name and address:

May 2011 August 2014 Summer Custodial Help: I clear out the rooms of all the furniture, wash down the rooms, wash down the furniture, either shampoo or wax the floors, Reason for leaving: also replace lights, do any heavy lifting Seasonal work, only in the summer Supervisor: Randy Werner Telephone: 641-324-0000

Position title/duties, skills:

Start date:

End date:

Reason for leaving: Pay: $ Per: Employer name and address:

Supervisor: Position title/duties, skills:

Telephone: Start date: End date:

Reason for leaving: Pay: $ Per: Employer name and address:

Supervisor: Position title/duties, skills:

Telephone: Start date: 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 HS

Years completed
4 General

Field of study
2014

Graduate or degree

MILITARY
Are you a veteran? Duty/specialized training: Yes No

SKILLS & QUALIFICATIONS


Other qualifications such as special skills, abilities or honors that should be considered:
I am good at anything dealing with chemistry and mathematics.

Types of computers, software, and other equipment you are qualified to operate or repair:
N/A

Professional licenses, certifications or registrations:


N/A

Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employers attention:
I've taken three years of Spanish.

Typing speed: N/A

per minute

REFERENCES
List two personal references who are not relatives or former supervisors.
JoAnne Alexander Name Rachele Elphic Name

420 Superhero Way, Northwood, IA 50459 Address


240 Villan Avenue, Helena, ND 12345 Address

641-324-0000 Telephone 123-456-7890 Telephone

retired Occupation Secretary/book keeper Occupation

10 Years known
15 Years known

CONTACT
In case of accident or illness, please contact: Name: Jennifer Costello 425 Superhero Way, Northwood, IA 50459 Address: Daytime phone: 641-390-0000 Relationship: Mother

INFORMATION TO THE APPLICANT


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.
Zachary Costello 2/6/14

Signature of Applicant

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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