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Employment Application
Name: Tenold Last Telephone: 641-390-1234 Address:
Tiarra

COMPANY OR EMPLOYER NAME:


Diamond Jo Casino

Position applying for:

Dishwasher

EMPLOYEE INFORMATION
Justine

First Email: Tenold_14@nkstudents.com

Middle Alternate telephone:

641-324-1822

200 3rd Street N, Northwood Iowa

Are you able to perform the essential functions of the position with or without accommodations?
x Yes

No 15 19 No 16 21 (Check one)

If necessary for the job are you older than:


14
x 18

If necessary for the job, I am able to: x Yes Work overtime? Yes Provide a valid Alaska Driver's License? If so, fill out the following: Issuing state: Type: Endorsement(s):
Hazardous Material Tankers School Bus No Any Split

No x No

Passengers

I am legally eligible for employment in the U.S.?


x Yes

Tank with Hazardous Materials Double/Triple trailers Swing Rotating

I am seeking a permanent position:

x Yes

Work the following shifts: (check all that apply)


x Day
x Night Other: 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. Tiarra Tenold

Employer name and address:

Position title/duties, skills:


Dishwasher/ Do the dishes, Wash the machine, take out garbage, be responsible and get along with co-workers.

Start date:
11/9/12

End date:

Present

200 @ 3rd Street N NorthwoodIowa Pay: $ 9.33 Per: hour

Reason for leaving:

Employer name and address:

Supervisor: Tony Position title/duties, skills:

Telephone: 641-323-1233 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

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Summarize other employment related to this job:

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

Years completed
12 N/A N/A N/A

Field of study
N/A N/A N/A N/A

Graduate or degree
Graduate N/A N/A N/A

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

Typing speed:

N/A

per minute

REFERENCES
List two personal references who are not relatives or former supervisors.
Kelsey Katcher Name Zoie Stapelkamp Name 800 2nd Street W Address 101 18th Street N Address 641-390-1220 Telephone 641-324-1015 Telephone Waitress Occupation Hostess Occupation 16 Years known 9 Years known

CONTACT
In case of accident or illness, please contact: Name: 200 3rd Street W Address:
Suzie Reyerson

Daytime phone: Relationship:

641-390-1222 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. Tiarra Tenold 1-15-14

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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