Employment Application Form

Employment Application

Fill the form below accurately indicating your suitability to job applying for.
Position Applying For*
What type of work are you looking for*

Part-timeFull-timeEither
Applicant Name:*

First NameLast Name
Phone Number:*

Area CodePhone Number
E-mail Address:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Skills & Training
Please briefly describe your qualifications for the job :*
Please indicate highest level of education completed*

Some high schoolGraduated high schoolSome college/tradeschoolGraduated college/tradeschoolSome graduate schoolGraduated with a master's degree
Training or Certifications:
Upload Resume:

Upload a File

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References Please list two (2) references that are familiar with your work life.
Reference 1
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years Known:*
Relationship*
Reference 2
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years Known:*
Relationship*
Are you legally able to work in the U.S.?*

YesNo
Are you 18 years of age or older?*

YesNo
Have you ever applied to work here before?*

YesNo
If so, when?
Have you ever worked here before?*

YesNo
If so, when?
If so, what was the reason for leaving?
Are you available for work year-round?*

YesNo
What days and hours are you available?*
If offered employment, when would you be available to start?*
I certify that the information contained in this application is correct, and I understand that falsificatioin or omission of pertinent facts will be cause for refusal of employment. I hereby authorize Chemung County Humane Society & SPCA and its agents to contact my references and prior employers, perform a criminal background check, and release CCHS & SPCA and informants from all liability resulting from such an investigation.
By typing your full name you agree to the above paragraph*
Date*

MonthDayYear
Date
Should be Empty: