This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all questions completely and accurately. False or misleading statements during the interview or within this form are grounds for terminating the application process or, if discovered after employment, terminating employment.

Name: ______

last first m.i. date

Home Phone: ______Work Phone: ______

Current Address: ______

STREET CITY ST ZIP

Prior Address: ______

STREET CITY ST ZIP

AVAILABILITY

For which position are you applying? ______

What date can you start? ______Wage/Salary Desired: $______per hr.

Would you accept full-time work? £ Yes £ No Part-time? £ Yes £ No

Are you willing/able to work weekends and holidays? £ Yes £ No

EDUCATION: Please circle highest grade completed: 7 8 9 10 11 12 13 14 15 16 16+

Name City/State Degree?

High School

College
Other
Describe any special training, skills and extracurricular activities, if applicable:
State any additional information you feel might be helpful to us in considering your application:

Have you ever been convicted or pleaded guilty to the commission of a crime, either a felony or a misdemeanor? £ Yes £ No

If so, state specifically, and not generally, the date of such conviction or guilty plea, the place or court where such conviction or guilty plea was entered, the crime or offense with which you were charged, and whether you were convicted or entered a guilty plea. Also, state the punishment, either fine, imprisonment, or both, imposed by the court in such proceeding, and any other mitigating circumstances or events that have occurred subsequently to such conviction. ______

______

______

______

EMPLOYMENT EXPERIENCE: Start with current or most recent employment (use a separate sheet if necessary)

Employer
/

Dates Employed

/

Job Duties

From / To
Address
/ Hourly Rate/Salary
Starting / Ending
Telephone Number(s)
Job Title:
/ Supervisor:
Reason for Leaving:
Employer
/

Dates Employed

/

Job Duties

From / To
Address
/ Hourly Rate/Salary
Starting / Ending
Telephone Number(s)
Job Title:
/ Supervisor:
Reason for Leaving:
Employer
/

Dates Employed

/

Job Duties

From / To
Address
/ Hourly Rate/Salary
Starting / Ending
Telephone Number(s)
Job Title:
/
Supervisor:
Reason for Leaving:

REFERENCES: Give name, address and telephone number of three references who are not related to you and are not previous employers:

1.

2.

3.

APPLICANT’S STATEMENT
I certify that all answers given herein are true and complete to the best of my knowledge. I hereby acknowledge that any employment relationship with Stay & Play Pet Resort is of an “at will” nature, which means the employee may resign at any time and the employer may discharge employee at any time with or without cause. In the event of employment, I understand that all false or misleading information given in my application and/or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of my employer.

______

Signature of applicant Date

WE ARE AN EQUAL OPPORTUNITY EMPLOYER