Position(s) applied for *

Date of application *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Main phone number *

Alternate phone number

Email *

Desired Pay *

Date available to start *

Employment Experience

Please list the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references. Add an additional page if necessary.

Name of employer 1 *

Supervisor *

May we contact? *

Yes
No

Street address *

Phone number *

Dates Employed From *

Dates Employed To *

Job title and duties *

Reason for leaving *

Name of employer 2 *

Supervisor *

May we contact? *

Yes
No

Street address *

Phone number *

Dates Employed From *

Dates Employed To *

Job title and duties *

Reason for leaving *

Name of employer 3 *

Supervisor *

May we contact? *

Yes
No

Street address *

Dates Employed From *

Dates Employed To *

Phone number *

Job title and duties *

Reason for leaving *

Have you ever been involuntarily terminated or asked to resign from any job? *

Yes
No

If yes, please explain.

Please explain any gaps in your employment history.

Please list any other experience, job-related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment.

Education

Please describe your educational background in the table provided below.

High school *

Years completed *

High School Diploma/ degree? *

Yes
No

Did you attend College/University? *

Yes
No

College/ university

Years completed

Diploma/ degree

Yes
No

Area of study/major

Specialized training, skills, or extracurricular activities

Did you attend Graduate/Professional School? *

Yes
No

Graduate/ professional school

Years completed

Diploma/ degree

Yes
No

Area of study/major

Specialized training, skills, or extracurricular activities

Did you attend a Trade School *

Yes
No

Trade school

Years completed

Diploma/ degree

Yes
No

Area of study/major

Specialized training, skills, or extracurricular activities

Other Schooling? *

Yes
No

Other Schooling

Years completed

Diploma/ degree

Yes
No

Area of study/major

Specialized training, skills, or extracurricular activities

Business and Professional References

Please list three professional references of individuals who are not related to you.

Name and title *

Relationship *

Phone number or email *

Name and title 2 *

Relationship 2 *

Phone number or email 2 *

Name and title 3 *

Relationship 3 *

Phone number or email 3 *

Personal References

Please list three people who know you well.

Name and title *

Relationship *

Phone number or email *

Name and title *

Relationship *

Phone number or email *

Name and title *

Relationship *

Phone number or email *

General Information

Have you ever used another name? *

Yes
No

Have you ever been convicted of a felony or misdemeanor? *

Yes
No

If yes, please explain:

Are you available to work? *

Full-time
Part-time
Temporary

If hired, would you have a reliable means of transportation to and from work? *

Yes
No

Can you travel if the position requires it? *

Yes
No

Are you at least 18 years old? *

Yes
No

Note: If under 18, hire is subject to verification that you are of minimum legal age.

If hired, I am able to present evidence of your identity and legal right to work in this country? *

Yes
No

Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation? *

Yes
No

Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.

Applicant Statement and Agreement

Please read and initial each paragraph below. If there is anything that you do not understand, please ask.

I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the company any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. *

I Understand

In the event of my employment with the company, I understand that I am required to comply with all rules and regulations of the company. *

I Understand

If hired, I understand and agree that my employment with the company is at will and that neither I nor the company is required to continue the employment relationship for any specific term. I further understand that the company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications. *

I Understand

I understand that the safety of employees is extremely important to the company and that the company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health. *

I Understand

I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. *

I Understand

I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration law requires me to complete an I-9 Form in this regard. *

I Understand

I can lift 50lbs or more. *

Yes
No

We are a drug free workplace and will require a negative drug test prior to being hired at Kind Animal Care. We comply with the Drug-Free Workplace Act of 1988, which is a part of Public Law 100-690, Anti-Drug Abuse Act of 1988. Compliance is required as a condition of employment on such grant or contract and that employees must abide by the terms of the policy statement. The policy statement includes the requirement that employees notify the Company of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction. *

I Understand

My signature attests to the fact that I have read, understand, and agree to all of the above terms.

Clear Signature

Signature

Name *

First

Last

Date *

We can’t wait to meet you!

Application for Employment Form