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Employment – Application
Personal Information
Full Name
(first name, middle initial, last name):
Address:
City:
State:
-- Select --
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
DC
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Postal Code:
Home Phone Number:
E-mail Address:
In case of emergency, call:
Contact Email Address
Are you 18 or older?
Yes
No
Work Availability
Total hours available per week:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
From
:
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
To:
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
Are you legally able to be employed in the U.S.?
Yes
No
Do you have transportation to work?
Yes
No
How did you hear of the job?
School Most Recently Attended
Name:
Have you graduated?
Yes
No
Last grade completed:
Location:
Are you currently enrolled?
Yes
No
Favorite Subject:
Work History
(list most recent jobs first; if not applicable, list U.S. Military, volunteer work, or personal references)
Company [1]:
City:
Postal Code:
Phone:
Job Title:
Dates Worked:
From:
January
February
March
April
May
June
July
August
September
October
November
December
To:
January
February
March
April
May
June
July
August
September
October
November
December
Address:
State:
-- Select --
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
DC
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Supervisor:
Salary:
$
per
---Select---
hour
year
Reason for Leaving:
Company [2]:
City:
Postal Code:
Phone:
Job Title:
Dates Worked:
From:
January
February
March
April
May
June
July
August
September
October
November
December
To:
January
February
March
April
May
June
July
August
September
October
November
December
Address:
State:
-- Select --
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
DC
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Supervisor:
Salary:
$
per
---Select---
hour
year
Reason for Leaving:
Company [3]:
City:
Postal Code:
Phone:
Job Title:
Dates Worked:
From:
January
February
March
April
May
June
July
August
September
October
November
December
To:
January
February
March
April
May
June
July
August
September
October
November
December
Address:
State:
-- Select --
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
DC
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Supervisor:
Salary:
$
per
---Select---
hour
year
Reason for Leaving:
During the past seven years, have you ever been convicted of a crime?
(other than a misdemeanor)
Yes
No
Please read carefully...
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.
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.
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.
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.
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.
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.
Can you perform all job duties?
Yes
No
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