Employment Application - Animal Care Applicant InformationFirst Name, Middle Name, Last Name* Street Address* City, State, Zip* How long have you been an occupant of the address you listed above?* Previous Street Address* Previous City, State, Zip* Phone Number* Date of Birth (mm/dd/yyyy)* Email Address* Are you seeking a permanent position?*YesNoPlease select preferred status:*Full TimePart TimeSeasonalWhat is your minimum desired hourly pay? (must enter an amount)* Please enter the earliest time to latest time you are available to work:* What days are you available to work? (Example: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday)* If you are hired, when are you be available to start? (mm/dd/yyyy)* Are you legally eligible for employment in the U.S.?*YesNoA valid Ohio Driver's License is required. Please enter your valid Ohio Driver's License#* Have you ever been convicted of a crime?*YesNoIf you selected "Yes" to the above question, please describe the offense(s): Have you ever had any traffic-related offenses?*YesNoIf you selected "Yes" to the above question, please describe the offense(s): EducationDo you have a High School Diploma or an Equivalent?*YesNoHigh School/Equivalent Name, Street Address, City, State, Zip, Phone Number*Do you have a college degree(s)?*YesNoIf you selected "Yes" to the above question, please describe the degree(s): College Name, Street Address, City, State, Zip, Phone NumberAdditional Training, Skills, Licenses, CertificationsPlease list any training, skills, certifications and licenses that you've acquired for any occupation that you currently have or had:*Employment History (If you've had more than one job, you must list each one)Current Employer (If you are currently unemployed, please enter N/A):* Current Employer Street Address: Current Employer City, State, Zip: Current Employer Phone Number: What is your position title? Employer Start Date(mm/yy) What is your reason for wanting to leave? What is your current pay rate ($0.00)? #1 Past Employer: #1 Employer Street Address: #1 Employer City, State, Zip: #1 Employer Phone Number: #1 Employer position title? #1 Employer Start and end date (mm/yy to mm/yy)? #1 Employer ending pay rate ($0.00)? #1 Employer - What is your reason for leaving? #2 Past Employer: #2 Employer Street Address: #2 Employer City, State, Zip: #2 Employer Phone Number: #2 Employer position title? #2 Employer Start and end date (mm/yy to mm/yy)? #2 Employer ending pay rate ($0.00)? #2 Employer - What is your reason for leaving? #3 Past Employer: #3 Employer Street Address: #3 Employer City, State, Zip: #3 Employer Phone Number: #3 Employer position title? #3 Employer Start and end date (mm/yy to mm/yy)? #3 Employer ending pay rate ($0.00)? #3 Employer - What is your reason for leaving? #4 Past Employer: #4 Employer Street Address: #4 Employer City, State, Zip: #4 Employer Phone Number: #4 Employer position title? #4 Employer Start and end date (mm/yy to mm/yy)? #4 Employer ending pay rate ($0.00)? #4 Employer - What is your reason for leaving? References (Must list three - no family members)#1 Reference Name, Last Name* #1 Reference Phone Number* #1 Reference Occupation* #2 Reference Name, Last Name* #2 Reference Phone Number* #2 Reference Occupation* #3 Reference Name, Last Name* #3 Reference Phone Number* #3 Reference Occupation* QuestionnaireDo you understand that we are nonprofit, nongovernmental organization?*YesNoDo you understand that this position's wage begins at $10.75 per hour?*YesNoDo you understand that we DO NOT offer any medical coverage?*YesNoDo you understand that this is a 24 to 32 hour per week position?*YesNoIf necessary for the job, are you available to work past scheduled time and/or overtime?*YesNoIf hired, are you available to work on holidays and weekends?*YesNoHave you ever been employed by the Fayette Regional Humane Society?*YesNoIf you selected "Yes" to the above question, please explain the reason for leaving: Are you currently a volunteer at the Fayette Regional Humane Society?*YesNoDo you have any family members who are currently employed at the Fayette Regional Humane Society?*YesNoIf you selected "Yes" to the above question, what is the person(s) first and last name? Do you have any friends who are currently employed at the Fayette Regional Humane Society?*YesNoIf you selected "Yes" to the above question, what is the person(s) first and last name? Employees are exposed to animals in pain and suffering. Are you comfortable with this?*YesNoIf it is required to lift and/or carry an animal with a weight up to 75 pounds, are you able to do this?*YesNoEmployees may be exposed to handling all types of animals small and large. Are you uncomfortable to handle any certain animal(s)? It is okay to be uncomfortable handling certain types of animals. Please list animal type(s) below:* Do you know basic care of horses, cows, pigs, chickens or other large or livestock animals? If so, please list animal type(s) below:* Please list animal type(s) below that you have experience handling:* Employees are occasionally exposed to and must handle aggressive animals. Are you okay with this?*YesNoAre you comfortable with becoming a certified Euthanasia Technician post-hire? This training allows an animal care technician to humanely euthanize (put-to-sleep) animals to end any pain or suffering.*YesNoExplain why you want to be an employee at the Fayette Regional Humane Society:*What makes you feel qualified to work at the Fayette Regional Humane Society?*Do you have any animals at home?*YesNoIf you selected "Yes" to the above question, please list the kind of animals and how many: If you listed a dog(s) or cat(s), are they spayed or neutered?*YesNoIf you selected "No" to the above question, please explain why: You may be required to take a drug test. Are you okay with this?*YesNoApplicants are subject to a criminal background check. Are you okay with this?*YesNoIf you have a resume you may attach it to this completed application. You may upload the file here.Max. file size: 5 MB. Δ
