APPLICATION FOR EMPLOYMENT
We consider applicants for all positions without regard to race, color, religion, sex, national origin,
age, marital or veteran status, disability, or any other legally protected status.
If you would like to send your resume in addition to this application, please click here and forward your resume through email.
Complete all information and electronically sign. Incomplete applications may not be considered.
Date:
Job applied for:
Name:
Street Address:
City, State, Zip:
Phone(daytime):
Phone(home):
Email address:
Social Security Number:
Are you able to work:
Full Time
Part Time
Which locations would you prefer to be considered for employment:
First Choice
Cedar Falls, IA – College Square Mall
Cedar Rapids, IA – Blairs Ferry Rd
Cedar Rapids, IA – Lindale Mall
Dixon, IL
Dubuque, IA
Freeport, IL
Iowa City, IA
Marshalltown, IA
North Liberty, IA
Rock Falls, IL
Waterloo , IA
Waverly, IA
Corporate Office
Second Choice
Cedar Falls, IA – College Square Mall
Cedar Rapids, IA – Blairs Ferry Rd
Cedar Rapids, IA – Lindale Mall
Dixon, IL
Dubuque, IA
Freeport, IL
Iowa City, IA
Marshalltown, IA
North Liberty, IA
Rock Falls, IL
Waterloo , IA
Waverly, IA
Corporate Office
Number of hours per week
Please select shift and days available:
Any
1st Shift
2nd Shift
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
When are you typically available for an interview (times and days):
Can you work weekends:
Yes
No
On what date would you be available for work:
Are you 18 years of age or older:
Yes
No
Do you have the legal right to work in the USA:
Yes
No
Have you ever been convicted of a crime:
Yes
No
If yes, list all convictions:
Other skills/qualifications for this job (special training):
EDUCATION/TRAINING
High School
College/University
Other
School Name
City, State
Year Completed Degree
9
10
11
12
1
2
3
4
1
2
3
4
Received Diploma
Yes
No
Yes
No
Yes
No
Degree/Diploma Obtained
EMPLOYEEMENT EXPERIENCE
Start with your present or most recent job
1.Employer
Company Name:
Address:
Phone:
Job Title:
Supervisor:
Dates Employed:
From
To
Wages:
Start
End
Work Performed:
Reason For Leaving:
2.Employer
Company Name:
Address:
Phone:
Job Title:
Supervisor:
Dates Employed:
From
To
Wages:
Start
End
Work Performed:
Reason For Leaving:
3.Employer
Company Name:
Address:
Phone:
Job Title:
Supervisor:
Dates Employed:
From
To
Wages:
Start
End
Work Performed:
Reason For Leaving:
Please read before signing:
I certify that the information contained in this application is true, complete and correct to the best of my knowledge. I understand that any omission of facts or misrepresentation is cause for denial of employment and/or dismissal from employment. I authorize investigation of my background and all statements made on this application or in any pre-employment interview, including, but not limited to my employment record, personal references, school record and police record, if any.
I understand that this application for employment shall be considered active for a period of time not to exceed 12 months from the time it is received or reviewed. If I wish to be considered for employment beyond this time period, I understand that I will need to reapply at that time.
I understand that neither this document nor any offer of employment from Next Generation Wireless or its affiliates constitutes an employment contract unless a specific document is executed in writing by the Senior Executive of the applicable organization.
I understand that just as I am free to resign at any time if I am employed by Next Generation Wireless or its affiliates, the employer reserves the right to end my employment at any time with or without notice or cause (unless specifically excluded by another employment agreement.
Applicant's Signature
Date
