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APPLICATION FOR EMPLOYMENT

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, marital or veteran status, or any other legally protected status. Please fill out the application below or you can download an application and mail it to us at 1111 4th AVE NE P.O. BOX 189, INDEPENDENCE, IA 50644.

First Name *	Middle Name
Last Name *	Address 1 *
Address 2	City *
State *	ZIP *
Telephone No. *	Email *

EDUCATION

School	Name and Location	Course of Study	# Years Completed	Did you Graduate?	Degree or Diploma
Graduate				YesNo
College				YesNo
Business/Trade/Technical				YesNo
High School				YesNo
Elementary				YesNo

WORK EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, or other protected status.

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Work Performed

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Work Performed

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Work Performed

Please include any explanation of gaps in employment. * If none, state "none".

Describe any specialized training and apprenticeship programs. * If none, state "none".

Describe any job-related training received in the United States Military.

List professional, trade, business or Union Labor Organization affiliations. * If none, state "none".

Other Qualifications Summarize special job-related and qualifications acquired from other employment or experience.

State any additional information you feel may be helpful to us in considering your application.

Note to applicants: DO NOT ANSWER THE FOLLOWING QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given. YesNo

PERSONAL/PROFESSIONAL REFERENCES Do not include family members or past supervisors.
Name	Phone Number	Best Time to Call	Occupation

Applicant's Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by application law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledge in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Employer.

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Employment Application

APPLICATION FOR EMPLOYMENT

OR

EDUCATION

WORK EXPERIENCE

EMAIL

CONTACTS

ADDRESS