Iowa Laser Employment Application
Contact Information
Name (Last, First, Middle)
Current Address
City
State
Zip
Permanent Address
City
State
Zip
Date of Application
Current Telephone
Second Telephone
E-mail
Position(s) of Interest
What is the earliest date you can start?
Personal Information
If you are under 18 years of age, can you provide required proof of eligibility to work?
Yes
No
Are you at least 18 years of age?
Yes
No
Have you ever completed an application with us before?
Yes
No
Do you know anyone who has, or will be working with Iowa Laser?
Yes
No
If yes, who?
Have you ever been employed with Iowa Laser?
Yes
No
If yes, give date:
Are you currently employed?
Yes
No
May we contact your present employer?
Yes
No
If yes, give employer's contact name and telephone number:
Are you currently on layoff, or furlough status and subject to call?
Yes
No
Are you legally entitled to work in the United States?
Yes
No
Within the past seven (7) years, have you been convicted of a felony or released from incarceration?
Yes
No
(Conviction will NOT necessarily disqualify an applicant from employment.)
If your answer to the previous question is yes, please describe the circumstances of your conviction:
Education
Describe any specialized training, skills, apprenticeship, commerical driver license, job-related training received in the U.S. military and/or vocational training gained:
High School
School name and location
Years completed
9
10
11
12
College / University
School name and location
Years completed
1
2
3
4
Diploma/Degree (Yes or No, and degree named if applicable, and date received)
Yes
No
Degree:
Date:
Describe courses of study (major or emphasis)
Diploma/Degree (Yes or No, and degree named if applicable, and date received)
Yes
No
Degree:
Date:
Describe courses of study (major or emphasis)
Employment History
Begin with the most recent, and include complete addresses and telephone numbers. Send us additional information if needed.
Employer 1
Address
Name of supervisor or manager
Telephone
Employed (state month and year)
From:
To:
Monthly salary/hourly rate
Start: $
End: $
State job title and briefly describe your work:
Reason for leaving:
Employer 2
Address
Name of supervisor or manager
Telephone
Employed (state month and year)
From:
To:
Monthly salary/hourly rate
Start: $
End: $
State job title and briefly describe your work:
Reason for leaving:
Employer 3
Address
Name of supervisor or manager
Telephone
Employed (state month and year)
From:
To:
Monthly salary/hourly rate
Start: $
End: $
State job title and briefly describe your work:
Reason for leaving:
Employer 4
Address
Name of supervisor or manager
Telephone
Employed (state month and year)
From:
To:
Monthly salary/hourly rate
Start: $
End: $
State job title and briefly describe your work:
Reason for leaving:
References
Please provide the name, address, and phone number of three people, who are not related to you, and whom we can contact now.
Name (Last, First, Middle)
Phone
Address
Name (Last, First, Middle)
Phone
Address
Name (Last, First, Middle)
Phone
Address
Comments
EEO Questionnaire
This information is being gathered for affirmative action under Section 503 of the Rehabilitation Act of 1973. The information requested is voluntary and will be kept confidential. An applicant will not be subject to any adverse treatment for refusing to complete the questionnaire.
The purpose of this section is to assist in monitoring EEO1 statistics and to aid in complying with any required Government record keeping or periodic reporting. This information is not part of your employment application and will not be considered in the employment/selection process. If you choose to provide the information, please complete the following:
Title of job applied for:
City and State:
Race: (check one)
Select
White
Black / African American
Hispanic or Latino (All Races)
Hispanic or Latino (White Race Only)
Hispanic or Latino (All Other Races)
American Indian or Alaskan Native
Asian
Native Hawaiian or Other Pacific Islander
Sex:
Select
Male
Female
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