Iowa Donor Network - Registration

APPLICATION FOR EMPLOYMENT

Saving and Transforming Lives Through Organ and Tissue Donation, Transplantation and Education

Thank you for your interest in employment with Iowa Donor Network. We seek applicants for employment who are qualified, dedicated, and hardworking and who seek fulfilling employment. In return Iowa Donor Network offers competitive income, benefits and an excellent working environment. We are an equal opportunity employer and give employment and promotional consideration without regard to race, color, sex, religion, age, national origin, marital or veteran status, disability, sexual orientation, gender identity, or any other protected class as defined by local, state, or federal law.

Applicants seeking reasonable accommodation with the application and/or interview process should contact the Human Resources Manager.

Applicants may be subject to a background check and drug testing. Employment is conditional based upon the results of the background and drug screenings.
Applications are active for 30 days, but remain on file for one year.

Step 1 – Personal Information

Last Name:**

First Name:

Middle Initial:

Address:

City:**

State: ** Zip:**

Phone No : **[XXX-XXX-XXXX]

Cellular/Pager No :

Email Address :

Date of Application:

Are you 18 years or older? YES NO

Upon employment, can you provide genuine documentation establishing your identity and employment eligibility? YES NO

Have you ever been convicted of a crime or violation, other than a minor traffic infraction?
(A conviction record will not necessarily bar employment. Factors such as job relatedness, age of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.) YES NO

If yes,Please explain :

250 characters remaining

Step 2 – Employment

Employment Desired: Full Time Part Time

Position Applying For **

Date You can Start

Salary Desired

Ever Applied To Iowa Donor Network Before?: YES NO

If yes, Where:

If yes, When:

Referred By:

Are You Employed Now?: YES NO

If so May we Inquire Your Present Employer?: YES NO

If presently employed, why are you considering leaving:

250 characters remaining

Step 3 – Education

Did you graduate from High School or receive an equivalent degree?: YES NO

Other Formal Education

HIGHEST LEVEL

Name Of School:

City:

State:

Dates Attended: From : To :

Degree Obtained:

SECOND HIGHEST LEVEL

Name Of School:

City:

State:

Dates Attended: From : To :

Degree Obtained:

THIRD HIGHEST LEVEL

Name Of School:

City:

State:

Dates Attended: From : To :

Degree Obtained:

Step 4 – General

List any special course, seminars, and/or training that relate to the position for which you are applying

300 characters remaining

List any professional, trade, or civic organizations that relate to the position for which you are applying

300 characters remaining

[Omit any organization which reflects your race, color, sex, religion, age, national origin, marital or veteran status, disability, sexual orientation, gender identity, or any other protected class as defined by local, state, or federal law.]

Step 5 – Former Employers

List Last Three Employers, Starting With Most Recent First.
**Indicates Required Information. These Sections Must Be Completed; “See Attached Resume” Is Not Acceptable.

Name of Employer : **

Dates Employed : From :** To : **

Employer Address: **

Phone:

Last Position Held : **

Starting Wages: **

Ending Wages: **

Supervisor’s Name :

Reason for leaving : 300 characters remaining

List jobs held, duties performed, skills used or learned, and advancements or promotions while you worked at this company. Also list what you liked most and least about this job. :

600 characters remaining

Name of Employer : **

Dates Employed : From :** To : **

Employer Address: **

Phone:

Last Position Held : **

Starting Wages: **

Ending Wages: **

Supervisor’s Name :

Reason for leaving : 300 characters remaining

List jobs held, duties performed, skills used or learned, and advancements or promotions while you worked at this company. Also list what you liked most and least about this job. :

600 characters remaining

Name of Employer : **

Dates Employed : From :** To : **

Employer Address: **

Phone:

Last Position Held : **

Starting Wages: **

Ending Wages: **

Supervisor’s Name :

Reason for leaving : 300 characters remaining

List jobs held, duties performed, skills used or learned, and advancements or promotions while you worked at this company. Also list what you liked most and least about this job. :

600 characters remaining

Step 6 –Professional References
Give The Names Of Three Non-Relative Professional References, Whom You Have Known For At Least 1 Year.

Name:

Phone:

Business / Relationship:

Years Acquainted:

Name:

Phone:

Business / Relationship:

Years Acquainted:

Name:

Phone:

Business / Relationship:

Years Acquainted:

Step 7 –Additional Information

List any additional information you feel may be helpful to us in considering your application:

250 characters remaining

Step 8 – Signature and Authorization

I certify that the above information is true and correct and give authorization for investigation of all statements and information contained in this application, my resume, and other documents or verbally obtained during an employment interview. I voluntarily consent to allow Iowa Donor Network or designated representatives of Merit Resources, Inc. or any of its representatives or agents to check my references by contacting any persons, company of governmental entity they deem to be an appropriate reference. I understand these questions may pertain to my personal or educational background, work experience, character and behavior. I understand my employment is subject to satisfactory verification of this information and agree that deliberate falsification of this document or significant omissions shall be grounds for employment consideration disqualification or dismissal from employment, if discovered at a later date.

I understand that completion of this Application for Employment does not imply or guarantee employment by Iowa Donor Network. All employment by Iowa Donor Network is at-will and as such the relationship may be terminated by either Iowa Donor Network or myself, at anytime, with or without notice and with or without cause. I understand that company policies, procedures, practices or statements made during an interview or employment do not create an employment contract by implication or otherwise.

This application will be active for thirty days. If not contacted during that period of time, it may be necessary to complete another application to receive further employment consideration

Resume

Upload your Resume: Only pdf or word format is acceptable

Verification code:

Transmenu powered by JoomlArt.com - Mambo Joomla Professional Templates Club