Elmore SPCA Employment Application

1

Legal Name* This field is required.

First Name

Middle Name

Last Name

2

List any other names you have been known by.This includes maiden name (if applicable) or a previous legal name used before a name change.

3

Are you eligible to work in the United States?* This field is required.Upon hire all applicants will be required to provide required documentation.

YESNO

4

Are you 18 or over 18 years old?* This field is required.All applicants must be at least 18 years old.

YESNO

5

Date of Birth* This field is required.

6

Phone Number* This field is required.

7

Email

example@example.com

8

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

9

Have you ever been employed by Elmore SPCA?* This field is required.

YESNO

10

If Yes, dates of Elmore employment and reason for leaving?* This field is required.

11

Are you related to any current Elmore SPCA employee?* This field is required.

YESNO

12

If Yes, Please provide their name & relationship to you.* This field is required.

13

Are you able to lift and carry 60 pounds?* This field is required.Due to the type and size of our business all employees must be able to meet this requirement.

YESNO

14

I am available to work weekends?* This field is required.

YESNO

15

Employment preference?* This field is required.

Full-time?

Part-time?

16

Do you have reliable transportation to get to work?* This field is required.

YESNO

17

High School Education/GED* This field is required.If not applicable fill in N/A.

Name of School

Address

City, State

Did you Graduate?

Area of Study

If Yes, Date of Graduation

If Earned General Education Diploma, Provide Date.

18

Vocational/Technical Education* This field is required.If not applicable fill in N/A.

Name of School

City/State

Did you Graduate?

If No, # of Years Left to Graduate

If Yes, Date of Graduation

Degree or Certificate Received/Major

19

College Education* This field is required.If nonapplicable, Please fill in N/A.

Name of School

Address

City, State

If Graduated, Year of Graduation

If Not Graduated, # of years left until graduation

Degree Received/Major

20

Describe Computer Skills* This field is required.Identify any computer applications you have experience using in the last two years and your level of proficiency with each. Otherwise, enter NA or no recent use.

21

References

Please list three (3) references that are familiar with your work history.

Do NOT list relatives or former employers.

22

Reference* This field is required.Do NOT list relatives or former employers.

23

Reference* This field is required.Do NOT list relatives or former employers.

24

Reference* This field is required.Do NOT list relatives or former employers.

25

Work Experience

Please detail your entire work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Attach additional sheets if necessary. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer commitments. Do not complete this information with the notation "See Resume" PLEASE NOTE: Elmore SPCA, Inc. reserves the right to contact all current and former employers for reference information.

26

Work Experience* This field is required.If this is your first Job, please fill N/A in each box.

Dates Employed From:

Dates Employed To:

Full-time or Part-time, If part-time, # hours per week:

Title & Primary Duties:

Starting Salary & Final Salary:

Organization Name & Address:

Supervisor's Name, Title & Phone#:

Reason for Leaving:

27

Work Experience

Dates Employed From:

Dates Employed To:

Full-time or Part-time, If part-time, # hours per week:

Title & Primary Duties:

Starting Salary & Final Salary:

Organization Name & Address:

Supervisor's Name, Title & Phone#:

Reason for Leaving:

28

Work Experience

Dates Employed From:

Dates Employed To:

Full-time or Part-time, If part-time, # hours per week:

Title & Primary Duties:

Starting Salary & Final Salary:

Organization Name & Address:

Supervisor's Name, Title & Phone#:

Reason for Leaving:

29

Work Experience

Dates Employed From:

Dates Employed To:

Full-time or Part-time, If part-time, # hours per week:

Title & Primary Duties:

Starting Salary & Final Salary:

Organization Name & Address:

Supervisor's Name, Title & Phone#:

Reason for Leaving:

30

Work Experience

Dates Employed From:

Dates Employed To:

Full-time or Part-time, If part-time, # hours per week:

Title & Primary Duties:

Starting Salary & Final Salary:

Organization Name & Address:

Supervisor's Name, Title & Phone#:

Reason for Leaving:

31

Additional Work HistoryUse this section to submit additional work history that you were unable to list above. Be sure to include you name in this file, along with all other relevant work experience details.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

32

BackgroundPlease use this space to elaborate on background, experience, or qualifications that you believe should be considered in evaluating your qualifications for employment. You may include hobbies, volunteer experience, and other activities you believe may be relevant to your potential employment.

33

Resume and Files

Drag and drop files here

Select files to upload

Max. file size: 10.0MB

34

Training and Certifications

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Please read carefully and sign that you understand and accept this information.

I certify that the information on this application and its supporting documents are accurate and complete. I understand and agree that failure to fully complete this form, any misrepresentation, or omission of facts represents grounds for elimination from consideration for employment, or termination after employment, if discovered at a later date. I authorize Elmore SPCA, Inc. to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that employees of Elmore SPCA, Inc. serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law.

If employed, I will be required to furnish proof of eligibilty to work in the United States and to comply with company regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits, including paid time off. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first SIX MONTHS of regular employment represent a provisional period, during which I may be terminated without right of appeal.

36

Signature* This field is required.I read carefully and understand and accept the information on the previous page.