Employment Application Please enable JavaScript in your browser to complete this form.Name *FirstLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Date of BirthWho were you referred by?Date you can start?Are you presently employed?YesNoDesired SalaryIf so, where?Have you ever applied at the Humane Society of Stillwater before or worked here previously?If so, explain:Are you willing to provide transportation to the veterinarian?YesNoHave you ever been convicted of a crime causing harm to a person or animal?YesNoAre you pregnant, afraid of, or allergic to animals?YesNoEducation HistoryName of Schoolschool 2school 3Years Attendedyears 2year 3Did you graduate?graduate 2graduate 3Subjects Studiedsubject 2subject 3Former Employers1. Name and Address of Employer1. Start Date1. End Date1. Salary1. Position1. Reason for Leaving2. Name and Address of Employer2. Start Date2. End Date2. Salary2. Position2. Reason for Leaving3. Name and Address of Employer3. Start Date3. End Date3. Salary3. Position3. Reason for LeavingReferencesName *Name 2 *Name 3 *AddressAddress 2Address 3PhonePhone 2Phone 3Please explain any previous experiences with animals.AvailabilityPlease include the times you are free to be scheduled to workMondayTuesdayWednesdayThursdayFridaySaturdaySunday"I certify that all the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability and damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative."Signature Clear Signature DateSubmit
