Application for Employment s188
APPLICATION FOR EMPLOYMENT
(PLEASE PRINT PLAINLY)
We appreciate your interest in employment and assure you that we are interested in your qualifications. An understanding of your background and work history is necessary for us to properly place you in an available position
PERSONAL Date______
Social Security No.______Birth Date*______
Name______Sex*______
Last First Middle
Present Address______Telephone No.______
No. Street City State Zip
Position(s) applied for ______Rate of Pay Expected $______per hour
Would you work Full - Time _____Part - Time _____Specific days and hours if Part - Time______
Were you previously employed by this organization?______If yes, when?______
List any friends or relatives working here______
If your application is considered favorable, on what date will you be able to start work?______
Are there any work experiences, skills, or qualifications that you feel would especially fit you for work here?__
______
______
______
______
EDUCATION RECORD
Name of School Dates Attended Graduated Major Credit hours Grade List of Business Courses
From To Yes No Study Completed Average Subject Semester Completed
High School
College/University
Business, trade,
Correspondence,
Night School.
Other
Do you Type? Shorthand List the office equipment that you know how to operate:
Yes____ wpm______wpm
No_____
* DISCRIMINATION ON THE BASIS OF AGE OR SEX IS PROHIBITED BY STATE AND/OR FEDERAL LAWS, THIS INFORMATION IS REQUESTED FOR REPORTING PURPOSES PRIMARILY.
WORK HISTORY
Beginning with the most recent, list below all past employers, including any pertinent experience
Name of Company Business Address Phone Number
Type of Business Immediate Supervisor Date Employed From To
Exact Job Title Earnings at Hire Earnings at Termination Reason for Termination
Description of Duties
Name of Company Business Address Phone Number
Type of Business Immediate Supervisor Date Employed From To
Exact Job Title Earnings at Hire Earnings at Termination Reason for Termination
Description of Duties
Name of Company Business Address Phone Number
Type of Business Immediate Supervisor Date Employed From To
Exact Job Title Earnings at Hire Earnings at Termination Reason for Termination
Description of Duties
Name of Company Business Address Phone Number
Type of Business Immediate Supervisor Date Employed From To
Exact Job Title Earnings at Hire Earnings at Termination Reason for Termination
Description of Duties
EXTRA CURRICULAR AND SPECIAL ACTIVITIES
ATHLETICS, CLUBS, ETC.
(Do not include Military, Racial, Religious, or Nationality Groups)
Name or Description When did you actively Offices
of Organization Participate? Held
From To
PERSONAL REFERENCES
(Not former employers or relatives)
NAME AND OCCUPATION ADDRESS PHONE NUMBER
OTHER
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY ADDRESS PHONE NUMBER
NAMES OF FRIENDS OF RELATIVES EMPLOYED HERE ARE YOU AUTHORIZED TO WORK IN THE UNITED STATES?
HAVE YOU EVER BEEN CONVICTED OF A FELONY? IF YOU ANSWERED YES, PLEASE EXPLAIN
HAVE YOU PREVIOUSLY APPLIED HERE? HAVE YOU EVER WORKED ANYWHERE UNDER A DIFFERENT NAME?
IF YES, WHEN? IF YES, WHAT NAME?
Please list ALL SPECIFIC days and hours of availability:
QUESTIONS
1) Why are you applying for this position? ______
______
______
______
______
2) What would you do if an unruly pet was creating havoc in the waiting room and a technician was unavailable to help? ______
______
______
______
3) If hired, what attributes would you bring to Noah’s Ark? ______
______
______
______
4) Rate these items in order of importance:
1 being the most important and
5 being the least important:
______KNOWLEDGE
______ATTITUDE
______FLEXIBILITY
______PUNCTUALITY
______ACCURACY
Affidavit
I certify that all information I have provided in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I understand that the employer may request an ivestigative consumer report from a consumer report agency. This report may include information as to my character, reputation, person characteristics, and mode of living obtained from neighbors, friends, former employers, schools, and others. I understand that I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation. I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer (except as previously noted), past employers and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I UNDERSTAND THAT THIS APPLICATION OF SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH, OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE. I have read, understand and by my signature consent to these statements.
Signature ______Date ______