Click here to download a copy of this employment application form.
Are you willing to undergo a physical examination by your personal physician, or by a physician designated by Meth-Wick?
Do you have any relatives employed by Meth-Wick?
If yes, in which department?
How were you referred to Meth-Wick?
Position applying for – please be specific:
(Click here for a full list of positions we're currently hiring.)
The following conditions may be required at some point in a job assignment. If required, would you be willing to work:
1) Shift work?
2) Rotational work schedule?
3) Work other than Monday through Friday?
What date would you be available to begin work?
Graduated High School:
College Degree, Diploma or Certificate:
College Major/Field of Study:
Graduated Other Education:
Other Education Degree, Diploma or Certificate:
Other Education Major/Field of Study:
Do you have a record of founded child or dependent adult abuse, or have you ever been convicted of a crime in this state or any other state?
If yes, please briefly describe the circumstances of your conviction, indicating the date, nature and place of the offense and the disposition of the case:
Include your last five (5) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. (Incomplete information could disqualify you from further consideration.)
Supervisor's Full Name:
Reason For Leaving:
Base Rate Of Pay:
Summarize duties and responsibilities:
Do you have any objections to our contacting your present employer to verify the above information?
No, you may contact at any time.Do not contact now, contact at a later date.
Please give the names of three persons not related to you, whom you have known at least three (3) years.
Please Read the Following Statements Carefully:
I understand and agree to the terms and conditions listed above.
I hereby authorize the addressed individual, company or organization to furnish The Meth-Wick Community with any relevant information they may require to arrive at an employment decision, and do hereby release the addressed individual, company, or organization and all individuals connected therewith, including Meth-Wick, from all liability for any damage whatsoever incurred in furnishing such information.
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1224 13th Street NW
Cedar Rapids, IA 52405
Careers at Meth-Wick
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