Application For Employment

Your Information

Date:
Social Security:
Name: (First, Middle, Last)
Home Address:
City: State: Zip Code:
Home Telephone: Alternate Telephone:
Email Address:
Are you over age 18? Yes No
Are you authorized to work in the U.S. on an unrestricted basis? Yes No

Have you ever been convicted of a felony? Yes No
If so, please explain (dates, places, charges, etc.):


Type of Work Desired

Full time Part time Available during holidays?
Position desired:
Salary desired:
Date you can start:
Hours available:
Are you currently employed? Yes No May we contact your employer? Yes No

Education

High School: City & State:
Did you graduate? Yes No
College (if applicable): City & State:
Did you graduate? Yes No

Employment History
(Start with your current or most recent employment)

Company Name: Telephone:
Start date: End date:
Job Title: Salary:
Reason for Leaving:

Company Name: Telephone:
Start date: End date:
Job Title: Salary:
Reason for Leaving:

Employment References
(Please list 2 former supervisors that can speak about your work performance)

 
Name: Company:
Telephone: Relationship:
 
Name: Company:
Telephone: Relationship:

Animal Handling Experience (paid or volunteer)

Name of Facility: City & State:
Duties:
Name of Facility: City & State:
Duties: