Employment Online Application
The Blood Center of Iowa is an equal opportunity employer and will not discriminate in the hiring process on the basis of sex, religion, race, color or national origin, disability, or age.
Name:
Last
First
Middle
Address:
AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA MA MD ME MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PI SC SD TN TX UT VA VT WA WV WI WY
Street
City
State
Zip
Home Phone:
Alternate Phone:
SSN:
E-mail:
Referral Source:
Positions you are applying for
Have you ever applied at The Blood Center of Iowa before? (If yes, give dates and position)
Yes No
Have you ever been employed by The Blood Center of Iowa before? (If yes, give dates, position and reason for leaving)
Do you have any relatives who are currently employees of The Blood Center of Iowa? (If yes, give name(s) and relationship)
Date Available to Work:
Are you legally eligible for employment in this country?
Desired salary range or hourly pay rate? Per
Applying for: Full-Time Part-Time Temporary Internship
Have you ever been convicted of a misdemeanor or felony? (For the purposes of this question, "convicted" includes found guilty, plead guilty, plead no contest, or been given a deferred sentence or judgment.)
Note: A conviction record will not necessarily disqualify an applicant from employment. Factors such as date of offense, seriousness/nature of the offense and position applied for will be taken into account.
Employment History
Starting with your most recent employer, please provide the following information:
Employer:
Phone:
From:
To:
Starting Salary:
Ending Salary:
Starting Position:
Ending Position:
Description of Duties:
Reason for Leaving:
Explain any gaps in your employment, other than those due to personal illness, injury or disability.
Have you ever been fired or asked to resign from a job?(if yes, please explain)
Education and Training
School
Name and Location of School
Course of Study
# of Years Completed
Did You Graduate?
High School or GED
College
Other
Professional Licenses and/or Certifications
Type
License / Certificate #
State Issued
Skills and Qualifications
Summarize any special training, skills or professional affiliations that may assist you in performing the position for which you are applying.
Related Information
List special accomplishments, publication, awards, etc.
Is there any other job-related information you want us to know about you?
References
List name and telephone of three business/work references who are not related to you.
Name
Relationship
Telephone #
# of YearsKnown
Application Statement
I certify that all the information submitted by me on this application is true and complete and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and if I am employed, my employment may be terminated whenever it is discovered. I understand that completing this application does not constitute an offer of employment and that my application may be rejected for any reason. In consideration of my employment, I agree to conform to The Blood Center’s rules and regulations and I agree that this organization follows an “employment at will” policy that an individual who is hired may voluntarily leave employment and may be terminated by the employer at any time and for any reason. I also understand and agree that the terms and condition of my employment may be changed with or without cause and with or without notice at any time by The Blood Center. I understand that this employment application and any other employee-related documents are not contracts of employment. I expressly authorize without reservation, The Blood Center, its representatives, employees or agents to contact and obtain information for all references, employers, public agencies, licensing authorities and education institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
Affirmative Action Voluntary Information
The Blood Center of Iowa is an Equal Opportunity Employer. We will consider all applicants for positions without regard to sex, religion, race, color, national origin, disability or age. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of unlawful criteria.
In an effort to comply with requirements regarding government reporting and other legal obligations which may apply, we request that you complete this form. Your cooperation in providing the data is appreciated.
THIS FORM MAY BE COMPLETED BY THE APPLICANT ON A VOLUNTARY BASIS. THE INFORMATION PROVIDED WILL NOT BE USED FOR MAKING ANY EMPLOYMENT DECISION AND IT WILL BE FILED SEPARATELY FROM YOUR EMPLOYMENT APPLICATION AND KEPT CONFIDENTIAL IN ACCORDANCE WITH APPLICABLE LAWS AND REGULATIONS.
Gender: Male Female
Please check one of the followingEqual Opportunity Identification Groups:
American Indian / Alaskan Native Black Hispanic / Latino Asian White Other Pacific Islander
I certify that I have read, fully understand and accept all terms of the Applicant Statement.
