Tiger Creek Animal Sanctuary Employment Application

Full Name *

Last Name First Name Middle Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Date Available

Date

Desired Hourly/Salary:

Position Applied For:

Animal CareFacilities and MaintenanceGuest ServicesPark Services

Are you a citizen of the United States?

YesNo

If no, are you authorized to work in the U.S?

YesNo

Have you ever worked for this company?

YesNo

If yes, when?

Have you ever been convicted of a felony?

YesNo

If yes, explain:

Have you ever been convicted for any crime including sex related or child abuse related offences?

YesNo

High School Name and Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What years did you attend?

Did you graduate?

YesNo

Diploma:

College Name and Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What years did you attend?

Did you graduate?

YesNo

Degree:

Other:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What years did you attend:

Did you graduate?

YesNo

Degree:

Company:

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor:

First NameLast Name

Job Title:

Starting Hourly/Salary:

Ending Hourly/Salary:

Responsibilities:

Time Worked For This Company (From ____ to ____):

Reason For Leaving:

May we contact your previous supervisor for a reference?

YesNo

Company:

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor:

First NameLast Name

Job Title:

Starting Hourly/Salary:

Ending Hourly/Salary:

Responsibilities:

Time Worked for This Company:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YesNo

Company:

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor:

First NameLast Name

Job Title:

Starting Hourly/Salary:

Ending Hourly/Salary:

Responsibilities:

Time Worked for This Company:

Reason For Leaving:

May we contact your previous supervisor for a reference?

YesNo

Skills and experience that is relevant to the position you have applied for:

I certify that my answers are true and complete to the best of my knowledge. If this application leads to my employment, I understand that false or misleading information in my application or interview may result in my release.

Date

APPLICATION FOR RELEASE OFEMPLOYMENT RECORDS AND INFORMATION: In connection with my performance of services to _____________ (contracting company),I _________________________ understand that investigative inquiries are to be made of my consumer credit history, criminal convictions, workers’ compensation records, motor vehicle driving records, and other reports. These reports will include but are not necessarily limited to, information as to my character, general reputation, performance and experience as well as reasons for separation from previous employment. I understand that Information Network Associates, Inc. (INA) will be requesting information from various federal, state, local and other agencies that maintain records concerning my past activities relating to civil litigation, my driving, credit, criminal, education, previous employment and other experiences. I recognize further that INA may conduct a periodic background investigation during the course of my provision of professional services to_________ (contracting company), including a consumer credit report. I authorize all corporations, companies, credit agencies, persons, educational institutions, law enforcement agencies and former employers to release information they may have about me, and I release them, _________(contracting company) and INA from any liability and responsibility from doing so; further, I authorize the procurement of an investigative consumer report and understand that such a report may contain information as to my financial situation, background, mode of living, character and personal reputation. This authorization, in original and copy form, shall be valid for this and future reports that may be requested by __________ (contracting company) during the course of my provision of services to____________ (contracting company).I authorize, without reservation, any party or agency contacted by INA on behalf of ____________(contracting company) to furnish the above mentioned information and release INA and ____________(contracting company) of any and all liability of every kind and nature. I understand to aid in the proper identification of files or records pertaining to me, the following personal identifiers are necessary. This information is being sought for the sole purpose of performing a lawful background check as described above and is voluntarily furnished. I further understand that INA will comply with the federal Fair Credit Reporting Act (FCRA), Public Law 91-50815USC§ 16810 et Seq., the Health Insurance Portability and Accountability Act, the Driver’s Privacy Protection Act (DPPA) and all other relevant federal, state and local laws and regulations now in effect or as subsequently amended or adopted. It is understood that INA will only release these records to ____________(contracting company). I __________________________ certify that information contained on this form is true and correct.

Last Name First Name

Middle Name Maiden Name (If Applicable)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

SSN:*

DOB:

DL #:

State:

Signature

Witness

Date

Employment Application

Education

Previous Employment

Skills and Experiences

Disclaimer and Signature