PET ME SCRATCH ME APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT

Pet Me Scratch Me is an Equal Opportunity Employer.
Which location are you applying for? *

La Crosse Onalaska
Name

First Name Last Name
Date

Month Day Year
Date
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Are you 18+ years old?

Yes No
Are you 16-18 years old?

Yes No
You must be at least 16 years of age to work for Pet Me Scratch Me and will be required to provide appropriate work authorization documents to be considered for employment.
Are you eligible to work in the U.S. and are able to provide proof of eligibility?

Yes No
During the last seven years, have you been convicted* of a crime other than a minor traffic offense?

Yes No
If yes, provide date, type and location for each conviction.
*A conviction will not necessarily disqualify you from consideration for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.
Have you ever been fired for employment or asked to resign by an employer?

Yes No
If yes, provide date, company and details.

What is your availability?

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning
Afternoon
Evening

Can you work occasional overtime, including nights, weekends and/or holidays?

Yes No
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ONLY for positions that require driving your personal and/or rental vehicles for company business:
Do you have a valid driver's license?

Yes No
License Number
State
Class
Expiration Date
Has your license been suspended, have you had an DUI, have you received 2 or more speeding tickets or other major moving violations within the last 5 years?

Yes No
If yes, provide details, including dates.
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ONLY for positions in veterinary services, daycare, boarding, grooming and training:
Are you able to stand, walk, crouch and climb as needed throughout your entire shift?

Yes No
If no, provide details.
Are you able to lift and separate dogs and lift bags of dog food and other supplies as needed throughout your entire shift?

Yes No
If no, provide details.
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Employment Desired
Position you are applying for
Earliest start date
Desired hourly rate of salary range
Are you able to perform the essential functions of the job for which you are applying, with or without accommodation?

Yes No
Are you currently employed?

Yes No
If yes, may we contact your current employer?

Yes No
Have you ever worked for Pet Me Scratch Me (PMSM) or a company associated with PMSM?

Yes No
Do you know anyone who works for PMSM?

Yes No
If yes, please provide their name and their relationship to you.
How did you hear about us?
If you were referred, by who?

Education, Training & Skills

	Name	Location	Degree or Diploma?	Subjects Studied/Major
High School
Trade/Business School
College or University
College or University
Certifications

Additional education, training and/or skill
Employment History

Include your last seven (7) years of employment history starting with the most recent and working backwards in time. This section must be completed even if you have attached a resume. Incomplete information could disqualify you from further consideration.

	Employer Name	Employer Number	Job Title	Address	Immediate Supervisor and Title	Job Roles & Responsibilities	Reason for Leaving	Starting Hourly Rate/Salary	Ending Hourly Rate/Salary
Position 1
Position 2
Position 3
Position 4
Position 5
Position 6
Position 7

References

	Name	Phone	Email	Company & Title	Relationship
Reference 1
Reference 2
Reference 3

Resume and/or Cover Letter

Browse Files

Cancel of
Please read each statement carefully before signing.

Pet Me Scratch Me (PMSM) is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, national origin, age, gender, marital status, physical or mental disability, military status, or any other status protected by federal, state, or local law.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for PMSM to hire me. If I am hired, I understand that my employment will be “at-will” and that either PMSM or I may terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of PMSM has the authority to make any assurance to the contrary.

I attest with my signature below that all information provided in this employment application is true and complete and that no requested information has been concealed. I authorize PMSM to investigate any or all statements contained in this application and to contact any references provided for employment verification and reference checks. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of further consideration for employment or immediate dismissal of employment, if discovered at a later date. Further, I understand that if I am extended an offer of employment, it may be contingent upon my successfully passing a pre-employment background check.

I have read, understand and by my signature consent to these statements.
Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

APPLICATION FOR EMPLOYMENT

Employment Desired

Employment History