EMPLOYMENT APPLICATION FORM

PLEASE DO NOT REAPPLY WITHIN 6 MONTHS OF THE DATE OF YOUR LAST APPLICATION

Name * Required
First Last
Address * Required
Street Address City State ZIP Code
Email * Required
Phone - Home * Required
Phone - Work * Required
May we contact you at work? * Required
- Yes
- No
Position(s) Desired, In Order Of Preference * Required
Hourly wage/Annual salary desired * Required
Date available for work * Required
MM slash DD slash YYYY
Age: Are you at least 18 year old? * Required
- Yes
- No
Age: Are you at least 21 year old? * Required
- Yes
- No
In order to permit a check of your work and education records, should we be made aware of any change of name or assumed name that you previously used? * Required
- Yes
- No
Identify name and date * Required
Name Date
Have you ever been employed by Elmbrook Humane Society before? * Required
- Yes
- No
Where? * Required
When? * Required
MM slash DD slash YYYY
Final Position * Required
Reason for leaving * Required
Do you have any relatives who either work or have previously worked for Elmbrook Humane Society? * Required
- Yes
- No
Please specify * Required
Have you previously applied for employment here? * Required
- Yes
- No
When? * Required
MM slash DD slash YYYY
Work Experience
Employer/Company * Required
Address * Required
Street Address City State ZIP Code
Phone Number * Required
Starting job title * Required
Starting Salary/Wage * Required
Last Job Title * Required
Final Salary/Wage * Required
Date Employed From * Required
MM slash DD slash YYYY
Currently Employed? * Required
- Yes
- No
Date Employed To * Required
MM slash DD slash YYYY
Immediate Supervisor * Required
Duties * Required
Reason for Leaving * Required
* Required
- Voluntary
- Involuntary
May we contact this employer? * Required
- Yes
- No
Add More Experience 1
- Add More Experience
Work Experience 2
Employer/Company * Required
Address * Required
Street Address City State ZIP Code
Phone number
Starting job title * Required
Starting Salary/Wage * Required
Last Job Title * Required
Final Salary/Wage * Required
Date Employed From * Required
MM slash DD slash YYYY
Date Employed To * Required
MM slash DD slash YYYY
Immediate Supervisor * Required
Duties * Required
Reason for Leaving * Required
* Required
- Voluntary
- Involuntary
May we contact this employer? * Required
- Yes
- No
Add More Experience 2
- Add More Experience
Work Experience 3
Employer/Company * Required
Address * Required
Street Address City State ZIP Code
Phone Number * Required
Starting job title * Required
Starting Salary/Wage * Required
Last Job Title * Required
Final Salary/Wage * Required
Date Employed From * Required
MM slash DD slash YYYY
Date Employed To * Required
MM slash DD slash YYYY
Immediate Supervisor * Required
Duties * Required
Reason for Leaving * Required
* Required
- Voluntary
- Involuntary
May we contact this employer? * Required
- Yes
- No
Education and Training
High School * Required
Click "+" to add more high schools
Name of School City State Number of years completed Graduated (Yes or No) Major or Course Type
College * Required
Click "+" to add more colleges
Name of School City State Number of years completed Graduated (Yes or No) Major or Course Type
Additional Training * Required
Click "+" to add more additional training
Name of School City State Number of years completed Graduated (Yes or No) Major or Course Type
Clerical * Required
Check if you have experience in the following:
- Data Entry
- Reception
- Word Processing Programs
- Spreadsheet Programs
- Switchboard
- Typing
What word processing programs do you use? * Required
What spread sheet programs do you use? * Required
Typing Speed (words per minute) * Required
Please enter a number from 0 to 500.
Animal Welfare or Veterinary Clinic Experience
Animal Welfare or Veterinary Clinic Experience
- None
Animal Welfare or Veterinary Clinic Experience * Required
- Customer Service
- Cashiering
- Animal Handling
- Grooming
- Kennel Cleaning
- Animal Behavior
- Maintenance/Repair
- Vet Technician
- Other
Others * Required
Permission to Work
Are you legally authorized to work in the United States? * Required
- Yes
- No
Conviction Record
Have you been convicted of a crime within the last 5 years? * Required
- Yes
- No
(An affirmative answer will not necessarily disqualify you from employment.)
Details of Crime * Required
Date of Crime * Required
MM slash DD slash YYYY
Physical Limitation - Emergency Notification Designation
Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation? * Required
- Yes
- No
Please describe any accommodations required. * Required
Please describe any accommodations required.
Person to notify in case of emergency: * Required
Phone * Required
Address * Required
Street Address City State ZIP Code
Referral Source
Check One * Required
- EBHS Website
- Employee Referral
- Newspaper ads
- School/College
- Walk-In Applicant
- Other
Name * Required
Indicate Other Source * Required
Applicant's Statement
Consent * Required
I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that any falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. * Required
Consent * Required
I authorize a thorough investigation of my past employment and activities, agree to cooperate in such investigation, and release from all liability or responsibility all persons and corporations requesting or supplying Information, I further authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the job for which I am being considered or any future job in the event I am hired. * Required
Consent * Required
I hereby agree to submit to any lawful drug, integrity, or skills testing that may be required as a condition of employment or continued employment and understand that unless otherwise prohibited by law, refusal to submit to such testing during the course of my employment may result in disciplinary action, up to and including discharge. I further agree to submit to search of my person or of any locker or work area that may be assigned to me, and I hereby waive all claims for damages on account of such examination. * Required
Consent * Required
I understand that this application is valid for 6 months; I will reapply after that time if I am still interested in employment. I also understand that my employment is terminable-at-will, and that this application is not, and is not intended to be, a contract for continued employment. * Required
Signature * Required