Employment Application Form

Please list two references other than relatives or previous employers.
Reference 1:
Name*
Position*
Company*
Address*
Phone Number*
Please enter a valid phone number.
Reference 2:
Name*
Position*
Company*
Address*
Phone Number*
Please enter a valid phone number.
An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying:*
MILITARY SERVICE
Have you ever been in the Armed Forces?

YesNo
Are you now a member of the National Guard?

YesNo
If Yes, please list Specialty:
Date Entered

MonthDayYear
Date
Discharge Date

MonthDayYear
Date

WORK EXPERIENCE

Please list your work experience for the past three employers beginning with your most recent job held. If you were self-employed, give firm name.
Name of Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Name of Last Supervisor
Your Last Job Title
Started Employment

MonthDayYear
Date
Ended Employment

MonthDayYear
Date
Starting Pay or Salary (annual)
Final Pay or Salary (annual)
Reason for leaving (please be specific):
List the jobs you held duties performed, skills used or learned, advancements or promotions while you worked at this company:
Name of Employer
Address

Street Address

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Name of Last Supervisor
Your Last Job Title
Started Employment

MonthDayYear
Date
Ended Employment

MonthDayYear
Date
Starting Pay or Salary (annual)
Final Pay or Salary (annual)
Reason for leaving (please be specific):
List the jobs you held duties performed, skills used or learned, advancements or promotions while you worked at this company:
Name of Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Name of Last Supervisor
Your Last Job Title
Started Employment

MonthDayYear
Date
Ended Employment

MonthDayYear
Date
Starting Pay or Salary (annual)
Final Pay or Salary (annual)
Reason for leaving (please be specific):
List the jobs you held duties performed, skills used or learned, advancements or promotions while you worked at this company:

How many pets do you own?
Number of Dogs
Number of Cats
Number of Other Pets
Pet 1
Breed/type
Age
Spay or Neutered?
Yes or No
How long have you owned this pet?
Pet 2
Breed/type
Age
Spay or Neutered?
Yes or No
How long have you owned this pet?
Pet 3
Breed/type
Age
Spay or Neutered?
Yes or No
How long have you owned this pet?
Pet 4
Breed/type
Age
Spay or Neutered?
Yes or No
How long have you owned this pet?
May we contact your present employer?*

YesNo
Did you complete this application yourself?*

YesNo
If not, who did?*
PLEASE READ CAREFULLY
Authorization for Release of Information

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give LifeLine Animal Project permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release LifeLine Animal Project from any liability as a result of such contact. I also understand that (1) LifeLine has a drug and alcohol policy that provides for potential pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations as may apply.
Signature of applicant*

Clear
Date*

MonthDayYear
Date
LifeLine Animal Project is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability.
Should be Empty: