Job Application - Southeast Iowa Regional Airport

SOUTHEAST IOWA REGIONAL AIRPORT AUTHORITY
2515 Summer Street Burlington, IA 52601-3330 (319) 754-1414
fax: (319) 754-1424

Date

Position Applied For

Name *

Last First Middle

Date of Birth

Primary Phone No

Address

City

State/Province

Zip/Postal

Emergency Name

Phone No

EDUCATION Cite Specialized Training Other Than Formal Education On Reverse Side

High School

Dates Attended From

To

Name of School

Graduated

Yes

No

Date

GED

Yes

No

Date

Address

City

State/Province

Zip/Postal

Vocational Program

College

Dates Attended From

To

Name of School

Graduated

Yes

No

Date

Degree

Address

City

State/Province

Zip/Postal

Major

Other Schools

Dates Attended From

To

Name of Institution

Graduated

Yes

No

Date

Degree or Certification

Address

City

State/Province

Zip/Postal

Major/Type of Program

Present Job

Dates Employed From

To

Name of Employer

Type of Business

Address

City

State/Province

Zip/Postal

Company Phone No.

Your Position

Nature of Duties

Final Salary

Supervisor Name

Title

Reason for Leaving

EMPLOYMENT HISTORY List All Positions Held in Reverse Order, Present (or most recent) Job First

Previous Job

Dates Employed From

To

Type of Business

Name of Employer

Address

City

State/Province

Zip/Postal

Company Phone No.

Your Position

Nature of Duties

Final Salary

Supervisor Name

Title

Reason for Leaving

Add Remove

Text

Other Information

Military Dates of Service From

To

Branch

Rank

Duties

Discharge: Honorable

Other (Explain)

Qualifications and Skills

Describe Any Equipment Extensively Operated By You (Office, Construction, Buses, Trucks, Etc.)

Current License

Driver

Commercial Driver License

Chauffeur

None

No

State

License ever Suspended or Revoked?

Yes

No

Date

Reason

Ever Convicted Of A Crime (except minor traffic violations)?

Yes

No

Date

Offenses

Ever Collected Money Or Bonded?

Yes

No

For Whom?

Have you reviewed the job description or posting for the position sought?

Yes

No

(If yes, answer the following:)

Can you perform the “essential functions” of the position with or without reasonable accommodation?

Yes

No

List Any Specialized Training, Certificates Or Achievements & Dates Received.

References

List Three (Local Area Residents if Available)

Name

Position

Known How Long?

Phone No.

Add Remove

The Southeast Iowa Regional Airport Authority does not discriminate on the basis
of race, color, national origin, sex, religion, age, or
disability in employment or the provision of services

I hereby certify that the answers given and statements made by me on this Employment Application are true and correct & that there are no material omissions. I authorize my present and former employers to give Airport Authority officials any information regarding me or my performance and release such employers, including their representatives and their companies, from all liability from damage for providing requested information. I understand that should investigation disclose misrepresentation or falsification, I will be dismissed immediately, my application will be rejected and I will be disqualified from making future application with the Airport Authority.
I understand that any employment offered by the Airport Authority is “employment at will” and I may be terminated for any reason not violative of law (or a collective bargaining agreement where applicable). I understand my driving and any criminal records may be checked and I agree to submit to a pre-employment physical examination at Airport Authority expense following a conditional offer of employment. I also understand that the Airport Authority has a strict policy against illegal drug involvement by employees that can result in immediate disqualification or dismissal from employment for any such illicit activities occurring on or off the job.

Read The Foregoing Carefully!

Date

Signature of Applicant

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