Employment Application

An Equal Opportunity Employer Company is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization
Name:*

First NameLast Name
Birth Date

MonthDayYear
Are you over the age of 18? *

YESNO
Phone Number:*

area codePhone Number 000-0000
E-mail Address:
Can we text you?
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment History:

Below, please describe past and present employment positions. Starting with most recent first.
Are you currently employed? *

YESNO
May we contact your current or past employers? *

YESNO
Employer #1 (most recent)

First NameLast Name
Supervisor Name:
Name / Job Title
Business Name / Type of Business
Business Name / Type of Business
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Date Started:

MonthDayYear
Date
Employment Date Ended:

MonthDayYear
Date
Job Duties Performed:
Reason for leaving:
Employer #2 (most recent)

First NameLast Name
Supervisor Name:
Name / Job Title
Business Name / Type of Business
Business Name / Type of Business
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Date Started:

MonthDayYear
Date
Employment Date Ended:

MonthDayYear
Date
Job Duties Performed:
Reason for leaving:
Upload Resume:

Upload a File

Cancelof
Job Skills & Training
Do you have any other experience, training, qualifications, or skills, which you feel, should be brought to our attention, in the case that they make you especially suited for working with us?.
Describe your skills:*
Training or Certifications:
References

Please list two (2) references that are familiar with your work life. Please include professional references only.
Reference 1
Occupation*
How you know this reference.
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2
Occupation*
How you know this reference.
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Positions*

Sale AssociateStockKennel/Animal Caretaker
Are you applying for:
What (week day) hours are you available to work?*

Days 9AM-3PMNights 3PM-8PMKennels 8AM-3PMAfternoon Kennels 3PM-5PM
What (weekend) hours are you available to work?*

Saturday 9AM-3PMSaturday 3PM-8PMSunday 10AM-5PMKennel 8AM-4PM
Is there any time/day that you are not available to work? *
If hired, on what date can you start working? *
Date
Desired Salary
$ per hour
If hired, would you have transportation to/from work? *

YESNO
Are you able to:*

Lift 25 lbs.Lift 50 lbs.BendSquatHandle DogsHandle CatsHandle BirdsHandle RodentsHandle ReptilesCatch FishClean- up Animal feces, urine, vomit etc.DustUse a computer
Have you ever been convicted of animal abuse or any criminal offense (felony or misdemeanor)? *

YESNO
If yes, please describe the crime - state nature of the crime(s), when and whereconvicted and disposition of the case
Please Read and Initial Each Paragraph, then Sign Below
I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from Diane’s Pet Supplies.*
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I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice.*
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I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release Diane’s Pet Supplies, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.*
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Clear
Applicant's Signature:
Should be Empty: