Employment Application

Name

First

Last

Social Security Number

Phone

Street Address

City

State

Zip Code

Age (Check One)

Minor 15-17 years

Adult 18 years or older

Desired Position

Date you can start:

Availability

Previous Employer 1

Phone Number

Job Title

Start Date

Leave Date

Reason For Leaving

Supervisor:

May We Contact this Employer?

Yes

No

Previous Employer 2

Phone Number

Job Title

Start Date

End Date

Reason For Leaving

Supervisor

May We Contact This Employer?

Yes

No

Previous Employer 3

Phone Number

Job Title

Start Date

End Date

Reason For Leaving

Supervisor

May We Contact This Employer?

Yes

No

High School Attended:

Did You Graduate?

Yes

No

College Attended:

Degree Earned/Worked Toward:

Did You Graduate?

Yes

No

Reference 1

Phone

Reference 2

Phone

Reference 3

Phone

Have you ever worked for or volunteered at an animal shelter before?

Yes

No

If yes, where and what were your responsibilities?

There are times that we do have to euthanize animals. What do you think of euthanasia?

Please list any additional skills or experience you think would be pertinent to this position:

Have you ever been convicted of a felony?

Yes

No

If yes, please explain:

Please list all misdemeanor offenses, including ANY animal cruelty charges:

"I certify that the facts contained in this application are true and complete to the best of my knowledge and I 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 and employers 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 the company from all liability for any damage that may result from utilization of such information. I understand Marion Area Humane Society is an equal opportunity employer and my race, gender, religion, etc. will not exclude me from consideration of employment with this company."
Signature:

Date: