Blank General Employment Application Form

Employment Application

COMPANY OR EMPLOYER NAME: World Wide Robotics

Position applying for:

Full Time Biomedical Engineer

EMPLOYEE INFORMATION Name:

Neymeyer

Isaac

Last Telephone: 5632759872 Address:

Brady

First Email:[email protected]

Yes

If necessary for the job, I am able to: X Yes Work overtime? Provide a valid Alaska Driver's License? X Yes If so, fill out the following: Issuing state: Type:

No

If necessary for the job are you older than: 14

15

18

19

16

X

(Check one)

Endorsement(s):

21

I am legally eligible for employment in the U.S.?

X Yes

5636500898

601 Fox Ridge Rd Eldridge, IA 52748

Are you able to perform the essential functions of the position with or without accommodations?

X

Middle Alternate telephone:

No

I am seeking a permanent position:

X

Yes

No

Hazardous Material

No No

Passengers

Tankers

Tank with Hazardous Materials

School Bus

Double/Triple trailers

Work the following shifts: (check all that apply)

I will be able to report to work 2 days after being notified I am hired.

Any

X

Split

Day

Night

Graveyard

Swing

Rotating

Other:

EMPLOYMENT HISTORY List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.

Employer name and address:

Helium Trampoline Park Pay: $ 8 Hour Per: Employer name and address:

Position title/duties, skills:

Start date:

Jump Patrol, Cafe, Front Desk Billy Gene Supervisor: Position title/duties, skills:

5638675309 Telephone:

Pay: $ 9 Per: Hour Employer name and address:

Was not getting scheduled as much as I requested Start date:

University of Iowa Cafe Pay: $ 10 Hour Per: Employer name and address:

Supervisor: Position title/duties, skills:

End date:

6/13/19

Reason for leaving:

Lifeguard Kristen Smith

4/25/2015

Reason for leaving:

6/24/16 North YMCA

End date:

12/12/2015

Went to College 5632987648 Telephone:

Make, clean, and organize the food

Start date:

End date:

8/12/19

4/23/21

Reason for leaving:

Anthony Vandivier Supervisor: Position title/duties, skills:

4569876543

Graduated

Telephone: Start date:

End date:

Reason for leaving: Pay: Per:

$

Rev. 8/2010

Supervisor:

Telephone: Employment Application

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Summarize other employment related to this job:

EDUCATION Years completed

Institution name

North Scott High School High school University of Iowa College/university University of Iowa Business/technical Additional

4 4 4

Field of study

Graduate or degree

High School Diploma Bachelor's Engineering Minor's Business

General Biomedical Engineering Business MILITARY

Are you a veteran? Duty/specialized training:

Yes

X No SKILLS & QUALIFICATIONS

Other qualifications such as special skills, abilities or honors that should be considered:

First in my class, won innovative technology competition all four years Types of computers, software, and other equipment you are qualified to operate or repair:

Java, C++, I am a quick learner and willing to try anything Professional licenses, certifications or registrations:

I am legally registered to use heavy equipment robots for certain purposes Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employer’s attention: Typing speed:

70

per minute

REFERENCES List two personal references who are not relatives or former supervisors.

Christy Lebeck Name

Brad Van Rooyen Name

No Name St. Park View IA Address

5634569876 Telephone

Clear View Drive, IA Address

6784567654 Telephone

My Whole Life

Accountant Occupation

Years known

Construction

My Whole Life

Occupation

Years known

CONTACT In case of accident or illness, please contact: Name: 601 Fox Ridge Eldridge IA Address:

Melissa Neymeyer

Daytime phone: 5636500898 Mother Relationship:

INFORMATION TO THE APPLICANT As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references. If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above.

Isaac Neymeyer

3/20/2024

Signature of Applicant

Date

Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment. Developed at employer request by the Alaska Department of Labor & Workforce Development, Employment Security Division. Rev. 8/2010

Employment Application

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