Employment

First Name:
Last Name: Middle Initial:

E-Mail Address:

Present Address:

City: State: Zip Code:

Phone Number:
Secondary Phone Number:

Are you over 18? Yes No

Are you a U.S. citizen? Yes No

Position(s) you are applying for:
Animal Care Receptionist Groomer Manager

Are you available part time or full time? Full Time Part Time

Salary Desired: Date Available:

Have you ever worked with animals before? Yes No

Days available to work:

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
From
To

Are you willing to work on holidays? Yes No

Are you willing to work an overnight shift? Yes No

Do you have any pets? yes No

If Yes, please describe:

EMPLOYMENT HISTORY

May we contact your current and/or previous employers? Yes No

1) Name and address of most recent or current employer:

Supervisor:
Phone Number

Start Date:
Leaving Date:

Description of work performed:

Reason for leaving:

2) Name and address of 2nd most recent employer:

Supervisor:
Phone Number

Start Date:
Leaving Date:

Description of work performed:

Reason for leaving:

3) Name and address of 3rd most recent employer:

Supervisor:
Phone Number

Start Date:
Leaving Date:

Description of work performed:

Reason for leaving:

Education

High school diploma? Yes No
Year Graduated:

Name and address of High School:

College Degree:
Year Graduated:

Name and address of College:

Major course of study:

Vocational school certification:
Year Completed:

Name and address of Vocational School:

Skills Learned:

Personal References:

1) Name Phone:
Years Known:

2) Name Phone:
Years Known:

3) Name Phone:
Years Known:

Have you ever plead guilty to or or no contest to a felony? Yes No

If yes, Please explain:

Please answer the following questions

Are you capable of standing for extensive periods of time and heavy lifting? Can you perform all physical aspects involved with the position you are applying for?
Yes No

If No, Please explain:

If you speak a foreign language, which one?

Have you had previous experience working with the public?
Yes No
If Yes, Please explain:

Typing your name in this box is equivalent to your signature:

Date: