The Animal Shelter of Sullivan County Application for Employment
Position Applying For
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Last Name
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First Name
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Street Address
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City
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State
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Zip Code
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Home Phone
Cell Phone
Driver's License Number and State
List High School, did you graduate?
Employment Reference #1 - List name and contact number
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Employment Reference #2 - List name and contact number
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Employment Reference #3 - List name and contact number
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Current/Most Recent Employer
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Dates Employed?
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Job Title and Basic Responsibilities
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Reason for Leaving?
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May we contact your current employer?
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No
Yes
Have you been convicted of a felony within the last seven years?
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No
Yes
If you have been convicted of a felony, please explain:
What makes you interested in working at the animal shelter and what experience do you have?
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I certify that the answers given within this application are true and complete to the best of my knowledge.
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No
Yes
I authorize the investigation of all statements, as may be necessary, contained in this application in arriving at an employment decision
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No
Yes
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in my discharge.
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No
Yes
Applicant Signature
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Date
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Together we can do great things for the homeless animals of Sullivan County
