EMPLOYMENT FORM

First Name: *

Last Name: *

Street Address (include apartment or lot #): *

City: *

State: *

Zip Code: *

Date of Birth: *

I Identify as: *

Social Security #: *

Contact Phone #: *

Contact Email Address: *

May we add your email address to our mailing list? *

Do you prefer full or part-time work?: *

When would you be available for work? *

What days would you be available for work? *

Have you ever been employed here before? *

Are you of legal age to work? *

Are you able to lift 50 pounds? *

Are you able to multi-task? *

Daily duties may include lifting bags of food and litter. Additionally, cages are rearranged frequently. Do you have any lifting restrictions? *

If yes, please explain the restrictions.

Have you ever been convicted of a crime? *

If yes, please list date(s) and crime(s) and what County if in Pennsylvania the conviction(s) occurred: If conviction occurred in another state, please indicate the town and state:

Grammar School Name and Location: *

Grammar School Course of Study: *

Did you Graduate? *

Choose One: *

High School Name and Location: *

High School Course of Study: *

Did you Graduate? *

Choose One: *

Do you have any college/graduate/vocational or other training? If yes, please fill out the College/Graduate/Vocational Education section that follows. If no, please move onto the Employment section below. *

College/Graduate/Vocational School Name(s) and Location(s):

College/Graduate/Vocational School Course(s) of Study:

Did you Graduate?

Choose One

Any additional information you would like to provide including any continuing education?

Previous Employer Name: *

Street Address (include apartment or lot #), City, State, Zip Code: *

Position: *

Start Date: *

End Date (if currently employed, choose today's date): *

Do you have any addtional employment history? If yes, please fill out the section that follows. If no, please move onto the next section. *

Previous Employer Name:

Street Address (include apartment or lot #), City, State, Zip Code:

Position:

Start Date:

End Date (if currently employed, choose today's date):

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time. *

In consideration of my employment, I agree to conform to the rules and regulations, and I agree that my employment and compensation can be changed or terminated, with or without cause or notice, at any time, at either my or the company’s option. *

I understand that it is the policy of the company to provide equal opportunity with regard to all terms and conditions of employment. The company complies with federal and state laws prohibiting discrimination on the basis of race, color, religion, creed, national origin, disability, veteran status, age or any other protected characteristic. *

Applicant's Signature: *

Today's Date: *