Linn County Extension

EMPLOYMENT APPLICATION

Linn County Summer Youth Assistant

Applications due: February 28 or until suitable applicant is found

An Equal Opportunity/Affirmative Action Employer

NOTE: Mail completed application,

To address above or email to or

Additional Employment History forms available upon request if needed OR attach a separate sheet in same format.

1. Full Name ______

Last First Middle

2. Telephone Number(s) ______

Area Code/Primary/Home Number Area Code/Alternate number

3. Address: ______

Street/P.O. Box/Apt. # City State Zip

4. Email address: ______

5. Are you 18 years or older? Yes No

6. Are you a U.S. Citizen? Yes No

7. Have you had prior employment with Linn County Extension? Yes No If yes:

______

Position Date(s)

8. Have you ever been convicted of a misdemeanor or felony? Yes No

If yes,* for what, where and when: ______

*A criminal conviction is not an absolute bar to employment but will only be considered in relationship to specific job requirements.

9. Are you related to any Linn County Extension employee who is in a supervisory position at Extension?

Yes No

If so, indicate employee’s name and department.

______

Name(s) Department(s)

EDUCATIONAL DATA

High School Graduate or Equivalent (GED)? Yes No

You may be required to provide a transcript

Name and location of college, university,

vocational/technicalschools (Most recent first) From To Credit Degree

Mo. / Yr. / Mo. / Yr. / Major or Course Title / SH/QH
a.
b.
c.
d.

If you had more than one position with the same employer, list each separately
If a job was part time, list the average number of hours worked per week.
When describing a job, list 3 or 4 major tasks performed and the approximate percentage of time spent on each task
Volunteer work experience will be evaluated in the same manner as paid employment and should be entered the same.

EMPLOYMENT HISTORY(Current)

Employer ______Duties: (Be Specific)

Employer’s Address & Phone # ______(1.) _____%

______

Type of Business ______

Supervisor’s Name ______

Your Title ______

Employed from ______to ______(2.) _____%

month/year month/year______

Average hours per week employed ______

Reason for leaving ______

______

List all machines/equipment/software used on the job:(3.) _____%

______

List number and titles(s) of employees supervised:(4.) _____ %

______

EMPLOYMENT HISTORY

Employer ______Duties: (Be Specific)

Employer’s Address & Phone # ______(1.) _____%

______

Type of Business ______

Supervisor’s Name ______

Your Title ______

Employed from ______to ______(2.) _____%

month/year month/year______

Average hours per week employed ______

Reason for leaving ______

______

List all machines/equipment/software used on the job:(3.) _____%

______

List number and titles(s) of employees supervised:(4.) _____ %

______

EMPLOYMENT HISTORY

Employer ______Duties: (Be Specific)

Employer’s Address & Phone # ______(1.) _____%

______

Type of Business ______

Supervisor’s Name ______

Your Title ______

Employed from ______to ______(2.) _____%

month/year month/year______

Average hours per week employed ______

Reason for leaving ______

______

List all machines/equipment/software used on the job:(3.) _____%

______

List number and titles(s) of employees supervised:(4.) _____ %

______

EMPLOYMENT HISTORY

Employer ______Duties: (Be Specific)

Employer’s Address & Phone # ______(1.) _____%

______

Type of Business ______

Supervisor’s Name ______

Your Title ______

Employed from ______to ______(2.) _____%

month/year month/year______

Average hours per week employed ______

Reason for leaving ______

______

List all machines/equipment/software used on the job:(3.) _____%

______

List number and titles(s) of employees supervised:(4.) _____ %

______

Tell us about your skills and experience relating to this position. (attach page if needed)

______

Three references that could speak of your skills and experiences relating to this position:

Name: ______ Cell # ______Work # ______Home: ______

Certification & Authorization

I certify that the information provided in my application for employment is true and complete to the best of my knowledge. I understand that any misrepresentation or omission of information may constitute rejection of my application for employment or may be cause for termination if employed.

I authorize representatives of Iowa State University Extension and Outreach to contact any of my former employers, the educational institutions that I have attended, or any other person organizations who have information relevant to my application for employment and for those individuals or organizations to release information relevant to my application for employment.

Signature: ______ Date: ______