EMPLOYMENT APPLICATION Last Name __________________________ First Name _______________________________________ Social Security Number ______ - ______ - ______ Date of Birth _____ / _____ / _______ Address _____________________________________________________________________________ City _____________________________________ State ______________________________________ Zip Code _________________________________ Phone _____________________________________ Have you ever worked for Animal Care? Yes ___ No ___ If yes, when? _________________________ What Position? ___________________________________ Are you a U.S. Citizen or an alien legally authorized to work in the U.S.? Yes ___ No ___ Do you have any relatives working at Animal Care? Yes ___ No ___ If yes, list name(s) & relationship(s) ______________________________________________________ ____________________________________________________________________________________ Have you ever pleaded guilty to or been convicted of any criminal offense (other than traffic violations)? Yes ___ No ___ If yes, please explain _____________________________________________________ ____________________________________________________________________________________ EMPLOYMENT DATA Status Desired: Full-time ___ Part-time ___ Are you willing to work weekends? Yes ___ No ___ Are you willing to work holidays? Yes ___ No ___ Position Desired ______________________________________________________________________ Date Available ____________________________ Pay Rate Desired ____________________________ EDUCATION High School ________________________________ State ________ Years Attended _______________ Did you graduate? Yes ___ No ___ College ____________________________________ State ________ Years Attended _______________ Did you graduate? Yes ___ No ___ (Page 1 of 3)
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EMPLOYMENT APPLICATION
___________________________________________ Age __________________________________ D.O.B
_______________________________________ Male Neutered Female Spayed
Vaccination History (Date of Last Vaccination) _______ ________ ______________________________
Pet’s Current Medications __________________________________________________________________
Give the name of two persons not related to you, whom you have know for at least 1 year:
1. Name ______________________ Relationship _________________ Phone Number _____________
2. Name ______________________ Relationship _________________ Phone Number _____________
FILING TEST
Please number 1 - 10 in alphabetical order:
_____ Radabaugh, Neil & Julie "Ralph"
_____ Smith, Steve & Cassie "Fudge"
_____ Wheelwright, George "Snoopy"
_____ Smith-Boisse, Julie "Duke"
_____ Drake, Stacey "Turtle"
_____ Smith, Steve & Kathy "Abby"
_____ Schaeffer, Diane & Ken "Bella"
_____ Shaffer, Kim "Charlie"
_____ Wheeler, Thomas & Sue "Jo-Jo"
_____ Drake, Stacey "Tiny"
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.
I understand and agree that if hired my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice."
Signature _________________________________ Date _____ / _____ / ________
