Employment Application Personal InformationEducationEmployment HistoryMore InformationEEO/AAFirst Name *Last Name *Address *State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPhone Number *Are you over 18 years of age? YesNoPosition(s) applied for *City *Zip *Referred By AdvertisementEmployment AgencyFriend RelativeNo OneAre you legally eligible for employment inside the United States? *YesNoLocation MarshalltownMason CityNew HamptonVintonWaverlyWaterlooAre you applying for full time or part time work Full TimePart TimeDays and hours available *Date you are available to start work *Desired Salary/Wage Have you ever worked for North Star Community Services? YesNoIf yes, when? What was your position? Special Qualifications/Skills If applying for a position that requires driving, do you have a valid drivers license? YesNoDrivers License Number How did you hear about this position? Online Job BoardCollege Placement OfficeCommunity Service AgencyJob Service/Employment AgencyNorth Star employee/volunteerOtherPlease explain High SchoolSchool Years Attended Location Did you graduate? YesNoTrade SchoolSchool Years Attended Location Did you graduate? YesNoCollegeName Years Attended Name (if applicable) Years Attended (if applicable) You will be required to provide documentation of your education. Can you provide this documentation? YesNoIf offered employment, you will be required to sign releases for a non-law enforcement record check and dependent adult abuse information.Location Did you graduate? YesNoLocation (if applicable) Did you graduate? (if applicable) YesNoEmployment HistoryStart with your most recent employerEmployer Position Location Employed From/To Duties Supervisor's Name Reason for Leaving Salary/Wage Permission to Contact Employer? YesNoEmployer Position Location Employed From/To Duties Supervisor's Name Reason for Leaving Salary/Wage Permission to Contact Employer? YesNoEmployer Position Location Employed From/To Duties Supervisor's Name Reason for Leaving Salary/Wage Permission to Contact Employer? YesNoUpload a Resume Drop your file here or click here to upload Upload a Cover Letter Drop your file here or click here to upload Military ServiceBranch of Service Rank and Duties Dates Discharge Date Volunteer BackgroundName of Organization Dates Tasks Performed Name of Organization Dates Tasks Performed Name of Organization Dates Tasks Performed ReferencesPlease provide three referencesName *Address *Name *Address *Name Address Phone Number *Years Known *Phone Number *Years Known *Phone Number Years Known EEO/AATo assist North Star Community Services in complying with federal, state, and local Equal Opportunity/Affirmative Action requirements, the following information is requested from persons applying for positions with this agency. Is it not required that you provide this information nor will it in any way result in adverse treatment.Please Check any that apply to youMale or Female MaleFemaleAge 18-2222-4445 or olderRace/Ethnicity WhiteBlackAsian AmericanHispanicNative AmericanOtherAre you a veteran? YesNoDo you have a physical or mental disability? YesNoPlease list any requests for accomadations to meet any physical or mental limitation Email< PreviousEducation Record >Submit Application
