Employment APPLICATION

Employment Application - Humane Agent

Applicant Information
Date (mm/dd/yyyy)*
First 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?*
Please select preferred status:*
What is your minimum desired hourly pay? (must enter an amount)*
Please enter a time frame that you are available to work? (Example: 7:00 a.m. to 7:00 p.m.)*
What days are you available to work? (Example: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday)*
What days do you prefer to have off? (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.?*
Are you able to provide a valid Ohio Driver's License?*
Please enter your valid Ohio Driver's License#*
Have you ever been convicted of a crime?*
If you selected "Yes" to the above question, please describe the offense(s):
Have you ever had any traffic-related offenses?*
If you selected "Yes" to the above question, please describe the offense(s):
Education
Do you have a High School Diploma or an Equivalent?*
High School/Equivalent Name, Street Address, City, State, Zip, Phone Number
Do you have a college degree(s)?*
If you selected "Yes" to the above question, please describe the degree(s):
College Name, Street Address, City, State, Zip, Phone Number
Additional Training, Skills, Licenses, Certifications
Are you currently a certified Ohio Humane Agent? (Not required prior to hire)*
If you selected "yes" to the above answer, please list any additional training, certifications and licenses you've received as a humane agent:
Please list any training, skills, certifications and licenses that you've acquired for any occupation that you currently have or had:
Employment History
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 and end date (mm/yy to mm/yy)?*
What is your reason for leaving?*
When was your ending pay rate ($0.00)?*
#1 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 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 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 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 (3)
#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*
Questionnaire
The Fayette Regional Humane Society is a nonprofit, nongovernmental organization. We want to make sure you understand that you would not be a governmental employee but an employee of a nonprofit organization. Are you okay with this?*
The humane agent position is 35 hours per week position, plus any additional hours required to work responding to animal emergencies after hours. Are you okay with this?*
Do you understand that we DO NOT offer any medical coverage?*
If necessary for the job, are you available to work overtime?*
If necessary for the job, are you available to work on holidays and weekends?*
Have you ever been employed by the Fayette Regional Humane Society?*
If you selected "Yes" to the above question, please explain the reason for leaving:
Are you currently a volunteer at the Fayette Regional Humane Society?*
Do you have any family members who are currently employed at the Fayette Regional Humane Society?*
If you selected "Yes" to the above question, what is the person(s) first and last name?
Humane Agents are required to complete the Ohio Basic Humane Agent training. At the end of the training, you will be required to complete and pass the examination to become a certified humane agent and to continue employment. Are you okay with this?*
During the Ohio Basic Humane Agent training, you will be required to learn "Subject Control" which is hands-on and physical. Principles may include but limited to subject approach, striking, takedowns, handcuffing, ground defense, body lock/hold releases, weapon defenses (i.e., weapon retention, shot avoidance, gun takeaways, edged weapon defense), and scenario management. Are physically able to complete this portion of the humane agent certification?*
Humane Agents are required to become a certified euthanasia technician post-hire. This gives the humane agent the ability to humanely euthanize (put-to-sleep) an animal by lethal injection to prevent and end pain and suffering. Are you okay with this training and feel comfortable performing this procedure on an animal?*
Humane Agents are required to complete Taser/Phazzer training and carry the device while on duty. Are you okay with this?*
Humane Agents are law enforcement officers and occasionally come into contact with and are exposed to potentially violent/dangerous people. Are you comfortable with this?*
Humane Agents occasionally come into contact with verbally aggressive people. Are you comfortable with this?*
Humane Agents are exposed to suffering animals resulting from severe emaciation (starvation), illnesses and/or injuries. Are you comfortable with this?*
If it is required to lift and/or carry an animal with a weight up to 75 pounds, are you able to do this?*
Humane Agents are required to handle all types of animal species, small and large. Are you uncomfortable handling 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 livestock animals? If so, please list animal type(s) below:*
Please list animal type(s) below that you have experience handling:*
Humane Agents are occasionally exposed to and must handle aggressive animals. Are you okay with this?*
Humane Agents issue citations and other court summons, and occasionally are required to appear in court to give testimony in reference to animal cruelty cases. Are you okay with this?*
Humane Agents are required to type a full, sometimes lengthy investigation report after each investigation. Are you able to successfully use proper spelling and grammar?*
Humane Agents are on-call for after-hour emergencies involving animals, which require a response at any hour, day, evening, night, overnight, weekends and holidays. This may sometimes interfere with personal or family activities where you must leave or end the activity should you need to respond to an animal in need of help. Are you okay with this?*
In order for humane agents to respond to animal emergencies with an appropiate amount of time, we require humane agents to residence within a reasonable distance. What is the distance between your place of residence to the Fayette Regional Humane Society?*
Humane Agents as well as all employees are required to complete continuing education classes every year to help them excel in their job performance. Are you okay with this?*
Humane Agents drive a large van during the performance of their duties. Are you comfortable with driving/operating this type of vehicle?*
Explain why you want to be a Humane Agent:*
What makes you feel qualified to be a humane agent?*
Do you have any animals at home?*
If 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?*
If you selected "No" to the above question, please explain why:
You may be required to take a drug test. Are you okay with this?*
Applicants are subject to a criminal background check. Are you okay with this?*
If you are not the chosen candidate for this paid position, would you be interested in becoming a Reserve Humane Agent, which is a volunteer and required to give a minimum of 10 hours per month of volunteer time?*
If you have a resume you may attach it to this completed application. You may upload the file here.
Max. file size: 5 MB.

Employment Application - Humane Agent

Applicant Information

Education

Additional Training, Skills, Licenses, Certifications

Employment History

References (Must list three (3)

Questionnaire

Contact Us

Hours

Quick Links