EMPLOYMENT FORM
CARBON COUNTY FRIENDS OF ANIMALS
77 WEST 13TH STREET
JIM THORPE, PA 1829
PHONE: 57032509400
First Name:
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Last Name:
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Street Address (include apartment or lot #):
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City:
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State:
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Zip Code:
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Date of Birth:
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I Identify as:
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Agender
Female/Woman
Genderqueer
Gender Fluid
Gender Non-Conforming
Intergender
Intersex
Male/Man
Nonbinary
Other
Transgender
Trans Man/Male
Trans Woman/Female
I do not wish to provide this information
Social Security #:
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Contact Phone #:
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Contact Email Address:
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May we add your email address to our mailing list?
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No
Yes
Do you prefer full or part-time work?:
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Part-time
Full-time
either
When would you be available for work?
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What days would you be available for work?
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Have you ever been employed here before?
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No
Yes
Are you of legal age to work?
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No
Yes
Are you able to lift 50 pounds?
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No
Yes
Are you able to multi-task?
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No
Yes
Daily duties may include lifting bags of food and litter. Additionally, cages are rearranged frequently. Do you have any lifting restrictions?
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No
Yes
If yes, please explain the restrictions.
Have you ever been convicted of a crime?
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No
Yes
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:
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Grammar School Course of Study:
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Did you Graduate?
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No
Yes
Choose One:
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Degree
Diploma
High School Name and Location:
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High School Course of Study:
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Did you Graduate?
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No
Yes
Choose One:
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Degree
Diploma
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.
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No
Yes
College/Graduate/Vocational School Name(s) and Location(s):
College/Graduate/Vocational School Course(s) of Study:
Did you Graduate?
No
Yes
Choose One
Degree
Diploma
Any additional information you would like to provide including any continuing education?
Previous Employer Name:
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Street Address (include apartment or lot #), City, State, Zip Code:
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Position:
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Start Date:
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End Date (if currently employed, choose today's date):
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Do you have any addtional employment history? If yes, please fill out the section that follows. If no, please move onto the next section.
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No
Yes
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.
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No
Yes
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.
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No
Yes
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.
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No
Yes
Applicant's Signature:
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Clear
Today's Date:
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Revised: March 2023