PERSONAL

Last Name:

First Name & MI:

Street Address:

City:

State:

Zip:

Phone:

Email:

Social Security Number:

Date Available:

Position Applying For:

Desired Salary:

Are you a US citizen?

YesNoNo, but authorized to work in US

Have you ever worked for this company?

YesNo

If so, when and what position?

Have you ever been convicted of a felony?

YesNo

If yes, explain:

Do you own an automobile?

YesNo

If yes, Year, Make, Model:

Is your drivers license in good standing?

YesNo

If no, explain:

EDUCATION

High School:

High School Address:

HS Start Date:

HS End Date:

Did you graduate High School?

YesNo

College:

College Address:

College Start Date:

College End Date:

Did you graduate from College?

YesNo

College Degree:

Other:

Other Address:

Other Start Date:

Other End Date:

Did you graduate?

YesNo

Degree:

REFERENCESPlease list three professional references

Reference 1 Name:

Reference 1 Company

Reference 1 Address:

Reference 1 Phone:

Reference 1 Relationship:

Reference 2 Name:

Reference 2 Company:

Reference 2 Address:

Reference 2 Phone:

Reference 2 Relationship:

Reference 3 Name:

Reference 3 Company:

Reference 3 Address:

Reference 3 Phone:

Reference 3 Relationship:

PREVIOUS EMPLOYMENT

Employer 1 Company:

Employer 1 Address:

Employer 1 Phone:

Employer 1 Supervisor:

Employer 1 Job Title:

Employer 1 Start Date:

Employer 1 End Date:

Employer 1 Responsibilities:

Employer 1 Starting Salary:

Employer 1 Ending Salary:

Employer 1 Reason for leaving:

May we contact Employer 1?

YesNo

Employer 2 Company:

Employer 2 Address:

Employer 2 Phone:

Employer 2 Supervisor:

Employer 2 Job Title:

Employer 2 Start Date:

Employer 2 End Date:

Employer 2 Responsibilities:

Employer 2 Starting Salary:

Employer 2 Ending Salary:

Employer 2 Reason for leaving:

May we contact Employer 2?

YesNo

Employer 3 Company:

Employer 3 Address:

Employer 3 Phone:

Employer 3 Supervisor:

Employer 3 Job Title:

Employer 3 Start Date:

Employer 3 End Date:

Employer 3 Responsibilities:

Employer 3 Starting Salary:

Employer 3 Ending Salary:

Employer 3 Reason for leaving:

May we contact Employer 3?:

YesNo

MILITARY SERVICE

Branch:

Service Start Date:

Service End Date:

Rank at discharge:

Type of discharge:

If other than honorable, explain:

GENERAL

What are you looking for in a job? Be specific.

Why do you want to work at Animal Paradise? Be specific.

DISCLAIMER AND SIGNATURE:

Date:

I have read disclaimer below and agree with the conditions.

I certify that my answers are true and complete to the best of my knowledge.  If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.