Hansen`s Farm Fresh Dairy Application for Employment

2-color-Panto
Hansen’s Ice Cream and Dairy Store
3015 Kimball Ave., Waterloo, IA 50702
(319) 234-3309
Hansen’s Farm Fresh Dairy Outlet
127 E. 18th St., Cedar Falls, IA 50613
(319) 226-3044
Hudson, Io
Hansen’s Farm Fresh Dairy Application for Employment
Today’s date __________________
H
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Application must be filled out completely. Please print clearly.
S
N
A EN’
Name_______________________________________________________________________________________________________
First
Middle
Last
W
A•
•H
Address______________________________________________________________________________________________________
S
D AI R Y
O
UD
Home phone______________________
CellIowa
phone______________________ E-mail_____________________________________
Hudson,
O
N
• Ia crime? o Yes o No
•
Are you legally able to work in the United States? o Yes o No
Have you ever
been convicted of
Age if under 18 ________ Date you can start work _________________ Number of hours desired per week _________________
Check one:
o Full time
o Part time o Temporary (until when)? ___________________________________________________
List the times you are available to work:
During school
Start
End
Summer
Start
End
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
List any activities/jobs that may interfere with your work schedule (sports, other employment, etc.)__________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
What do you enjoy doing in your free time? _ ______________________________________________________________________
___________________________________________________________________________________________________________
List schools attended__________________________________________________________________________________________
___________________________________________________________________________________________________________
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REFERENCES (other than relatives)
Name
Phone number
Nature of relationship
1.__________________________________________________________________________________________________________
2.__________________________________________________________________________________________________________
3.__________________________________________________________________________________________________________
EMPLOYMENT HISTORY (please begin with most recent employer)
Employer____________________________________________ Dates of employment_ ___________________________________
Address_____________________________________________ Phone number__________________________________________ Job Description_ _____________________________________ Supervisor_ ____________________________________________ Hourly wage/salary_ __________________________________ Reason for leaving_______________________________________ Employer____________________________________________ Dates of employment_ ___________________________________
Address_____________________________________________ Phone number__________________________________________ Job Description_ _____________________________________ Supervisor_ ____________________________________________ Hourly wage/salary_ __________________________________ Reason for leaving_______________________________________ Employer____________________________________________ Dates of employment_ ___________________________________
Address_____________________________________________ Phone number__________________________________________ Job Description_ _____________________________________ Supervisor_ ____________________________________________ Hourly wage/salary_ __________________________________ Reason for leaving_______________________________________ Why do you want to work for Hansen’s Farm Fresh Dairy?_____________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Why should Hansen’s Farm Fresh Dairy hire you?____________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
I acknowledge that the facts set forth on this application are true and complete. I understand that if employed, any false statement or omission on this application
or any attachment shall be sufficient cause for dismissal. I understand that Moo Roo and Hansen’s Farm Fresh Dairy Outlet are open seven days a week and that, if I
am employed, I may be scheduled to work any time or day of the week, including holidays.
I authorize Hansen’s Farm Fresh Dairy to verify ALL information on this application.
I understand that before I am hired, Hansen’s Farm Fresh Dairy may require me to undergo a physical examination and/or drug and/or alcohol test at any time during my employment. I agree to take such a test.
I understand and agree that this employment application by itself or together with other company documents or policy statement does not create a contract for
employment. I also understand that I may voluntarily leave or be terminated at anytime for any reason.
Signature________________________________________________________________________________ Date_ ________________________________________
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