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Job Application


Personal Information


Location:

Name:
Last: First: Middle Initial:

Address:
Number: Street:

City: State:    Zip:

Contact:
Phone: Email:

Are you 18 or older?
Yes     No

In case of emergency, call:

Contact Email Address:

Work Availability


  Mon Tue Wed Thurs Fri Sat Sun
From:
To:

Schools Most Recently Attended


  Name Location Years
Completed
Graduated?
High School:
College/University:
Graduate School:
Business/Trade:
Are you legally eligible to be employed in the United States? Yes No
(Proof of identity and eligibility will be required upon employment)

Do you have transportation to work? Yes No

Previous Employment


Name of Employer/Company:


Address:
Number: Street: City: State: Zip:

Contact:
Phone: Supervisor Name:

Your Job Title:

Dates of Employment:
From: To:

Reason for Leaving:


Ending Salary:



Name of Employer/Company:


Address:
Number: Street: City: State: Zip:

Contact:
Phone: Supervisor Name:

Your Job Title:

Dates of Employment:
From: To:

Reason for Leaving:


Ending Salary:



Name of Employer/Company:


Address:
Number: Street: City: State: Zip:

Contact:
Phone: Supervisor Name:

Your Job Title:

Dates of Employment:
From: To:

Reason for Leaving:


Ending Salary:

Please Read Carefully


1. I certify that the information contained on this application is correct to the best of my knowledge, and understand that any omission or erroneous information is grounds for dismissal in accordance with the policy of Iowa 80 Group. 2. I authorize the references listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. 3. I acknowledge that Iowa 80 Group reserves the right to amend or modify policies at any time, without prior notice. My application for employment is made with the understanding that nothing contained in this application or in the granting of an interview is intended to create a contract between Iowa 80 Group and myself for either employment or for providing of any benefit. My employment at Iowa 80 Group is at will. This means I am free to terminate my employment at any time, for any reason, with or without cause, and Iowa 80 Group retains the same rights. 4. Iowa 80 Group takes pride in being an Affirmative Action and Equal Opportunity Employer. Various federal, state and local laws prohibit discrimination on account of race, color, religion, sex, age, national origin, disability or veteran's status. It is Iowa 80 Group's policy to comply with these laws, as applicable, and information requested on this application will not be used for any purpose prohibited by law. 5. Iowa 80 Group regards drug abuse as a serious problem and maintains a drug-free environment. If I accept a job offer, a drug test, confirmed negative, will be required before the first day on the job. In addition, as a safeguard to my health and the health of my fellow employees, I will submit to such physical examinations, medical surveillance programs and tests for substance abuse during the course of employment as the Company may deem reasonable and necessary. Refusal or failure to take a test: immediate termination. 6. It is also my understanding, that if my employment with Iowa 80 Group lasts less than six weeks from my date of hire, I will reimburse Iowa 80 Group the entire amount of the cost of the drug screen.

I can perform all job duties. Yes     No

I can perform all job duties except:

During the past seven years, have you ever been convicted of a crime, Yes     No
other than a misdemeanor?

Spam Check:
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