DRHS ACT Job Application Form

ACT (Animal Care Technician) Application

Please Fill Out the Form Below to Submit Your Job Application
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DRHS Minimum Commitment Requirements of the ACT Role for Scheduling

All applicants:
- Must be available to work at least one weekend day per week (Saturday or Sunday)
- Must work a minimum of 10 hours per week
- Must be at least 16 years old
- Must rotate working holidays
ACT Scheduling Hours:
- 8:00am - 5:00pm
- 8:00am - 3:00pm
- 8:00am - 12:00pm
- 12:00pm - 5:00pm
Type of Work Desired:*

Part-timeFull-TimeTemporary
Earliest Possible Start Date*

MonthDayYear
List your availability, including each day of the week and the time period for those days (start and end time).*
Are there any animals you cannot work with? If yes, please explain. *
Do you feel confident in performing physical tasks required for this position? If no, please note accommodations that would help you.*
List any animal related associations or organizations you are involved in:*
List any special training or skills related to the position you are applying for:*
Are you able to perform the essential job functions of the job for which you are applying for, with or without reasonable accommodation?*

YesNo
Have you been employed at the DRHS before?*

YesNo
If yes, list the dates of previous employment at the DRHS:
Where you referred to apply to work here by a current DRHS staff member or active volunteer as a part of our Referral Bonus Program? If yes, please put that person's full name below. If no, please answer 'NA'*
Applicant Statement

I certify that all information given on this application is true and correct. I understand that the Dubuque Regional Humane Society will investigate my work and personal history and I authorize all persons, schools, companies, and law enforcement agencies to supply any information concerning my background and release them from any liability and responsibilities arising from their doing so. If hired, my employment would be "at will" which means I may be terminated at any time for any reason. I further understand that, if I am employed, any false statement, misrepresentation, or omission of facts on this application or on any supporting documents, regardless of when discovered to be false, will result in my immediate dismissal. And, if I am offered employment, I will, as condition of employment, be required to submit proof of my identity and legal right to work in the US within three (3) business days of my hire date.
Should be Empty:

ACT (Animal Care Technician) Application