Employment Application Form

Employment Application Form
Personal Information
Name*

First NameMiddle NameLast Name
Preferred Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Are you 18 years or older?*

YesNo
Employment Desired
Position for which you are applying
Work availability*

Full TimePart TimeEither
How many hours weekly?*
Date You Can Start*

MonthDayYear
Date
Weekly Availability
Sunday:*
Monday*
Tuesday*
Wednesday*
Thursday*
Friday*
Saturday*
Education
High School
Name of High School Attended
Number of Years Attended
Graduated?

Yes
College
Name of College/University Attended, if applicable
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Graduate School
Name of Graduate School Attended
Number of Years Attended
Graudated?

Yes
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Skills/Qualifications
Please describe any animal experience you have had in a professional setting.*
List any relevant skills
Please describe why your background and experience qualifies you for the position for which you are applying.*
List any relevant certifications or qualifications
Current Employment
Current Employer*
Name of Current Employer or NONE if not employed
Position
Description of Duties:
Name of Supervisor
Phone Number of Supervisor
Please enter a valid phone number.Format: (000) 000-0000.
May we contact your current employer?

YesNo
Reason for Leaving?
Start Date at Current Job

MonthDayYear
Date
Previous Employment
Previous Employer
Name of Previous Employer
Position
Description of Duties:
Name of Supervisor
Phone Number of Supervisor
Please enter a valid phone number.Format: (000) 000-0000.
May we contact your previous employer?

YesNo
Reason for Leaving?
Start Date at Previous Employer

MonthDayYear
Date
End Date at Previous Employer

MonthDayYear
Date
Previous Employer
Name of Previous Employer
Position
Description of Duties:
Name of Supervisor
Phone Number of Supervisor
Please enter a valid phone number.Format: (000) 000-0000.
May we contact your previous employer?

YesNo
Reason for Leaving?
Start Date at Previous Employer

MonthDayYear
Date
End Date at Previous Employer

MonthDayYear
Date
Questions
How would you be getting to CMHS to start your shift?*
Do you realize that the position we offer is physically demanding and that you would be responsible for, but not limited to, working with some chemicals, bending, lifting, scrubbing, others as assigned?*

YesNo
Do you understand that you could be asked to lift heavy items or animals?*

YesNo
If there is a reason you would be unable to fulfill the above aspect, please explain:
Working with the public is a large part of this position. Do you agree that people should be treated pleasantly, with kindness, respect, and patience?*

YesNo
How do you feel about the following...
Breeding dogs and cats:*
Pets inside or outside:*
Fencing, chaining or loose pets:*
Spaying and neutering:*
Euthanasia:*
Please tell us about pets you own, including what kind they are, where they are kept, and if they are spayed or neutered:*
Resume upload

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Employment Application Form

Personal Information

Employment Desired

Weekly Availability

Education

Skills/Qualifications

Current Employment

Previous Employment

Questions