Employment Application Form Order Number Personal Information First Name * Last Name * Email Address * Home Phone * Street Address City State Zip Code Employment Desired Position applied for? How did you hear about this position? Date available for work Desired hours (full time, part time, etc.) Position Manager Dog Trainer Groomer Bather Pet Care Technician Handy Person Education High School Name and Address Course of Study HS Years of Study Degree/Diploma Undergraduate College Name and Address Under Grad Course of Study Under Grad Years of Study Under Grad Degree/Diploma Graduate Professional Name and Address School Graduate Course of Study Graduate Years of Study Graduate Degree/Diploma List any seminars, classes or other education not listed above which may help qualify you for a position at Our House * Employment History List below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume. Employer 1 Address 1 Email 1 Start Date 1 City, State, Zip 1 Job Title 1 End Date 1 Phone 1 Supervisor 1 Work Performed 1 Fax 1 Reason for leaving 1 1 Reason for Leaving 1 What value did you add to this company or its customers? Employer 2 Address 2 Email 2 Start Date 2 City, State, Zip 2 Job Title 2 End Date 2 Phone 2 Supervisor 2 Work Performed 2 Fax 2 Reason for leaving 2 2 Reason for Leaving 2 What value did you add to this company or its customers? Employer 3 Address 3 Email 3 Start Date 3 City, State, Zip 3 Job Title 3 End Date 3 Phone 3 Supervisor 3 Work Performed 3 Fax 3 Reason for leaving 3 3 Reason for Leaving 3 What value did you add to this company or its customers? Additional Information List any professional, trade, business or civic activities and offices held. You may exclude any membership that would reveal gender, race, religion, national origin, ancestry, age, disability or any other protected status. List any languages other than English that you can speak, read or write: Please identify any specific animal or pet related experience that you have. Identify what skills you possess that make you most suited for the position applied for on this application: Explain how, if you are hired, you plan to add value to OHB: Identify what you believe are the most unique features of OHB: Skills and Qualifications Information (Please check yes or no) Have you ever been employed with this company before? Yes No Do you have any friends or relatives employed by this company? Yes No Are you currently employed? Yes No Are you currently on “lay off” status and subject to recall? Yes No If hired, can you provide proof of U.S. citizenship or proof of your legal right to live and work in this country? Yes No Are you able to perform the essential functions and duties of the job for which you are applying? (lifting 50+ lbs, walking or standing for long periods etc.) Yes No Regarding lifting. If not, please describe the functions or duties you are unable to perform: If hired, would you be able to travel and work overtime as needed? Yes No Do you understand that All holidays( Spring Break, Memorial Day thru August 8th,Labor Day ,Thanksgiving, Dec 20th thur Jan 8th are MANDITORY WORK PERIODS. Failure to work during these times if assigned will result in termination of your position. These dates are critical and someone will be hired to fill your position should you fail to work without prior approval in writing from your manager Yes No Do you understand that failure to show up for your assigned work day without calling your manager will be grounds for immediate termination. Texting is NOT acceptable. Yes No Do you understand that slander against Our House Braselton or any other employee will be grounds for termination . Yes No If yes, when? If yes, please provide their names and relationship to you: If employed, may we contact your current employer? Yes No If you are under 18 years of age, can you provide proof of your eligibility to work in the U.S.? Yes No If hired, are there any accommodations the company would need to provide so that you can perform all those essential functions and duties of the position being applied for? Yes No If yes, explain accommodation required: If hired, would you have a reliable means of transportation to and from work? Yes No Have you ever been treated for work related injuries by a doctor? Yes No If yes, explain injury/s and treatment/s: Do you understand that excessive tardiness ( more than one time in a two week period can result in termination) Yes No Do you understand that any use of Tobacco, Alcohol or non prescribed drugs while on premises will result in immediate termination. Yes No References List below three persons not related to you who have knowledge of your work performance within the last 5 years. References Name 1 References Phone 1 Company Name 1 Year Acquanted with Company 1 References Occupation 1 References Email 1 Company Address 1 References Name 2 References Phone 2 Company Name 2 Year Acquanted with Company 2 References Occupation 2 References Email 2 Company Address 2 References Name 3 References Phone 3 Company Name 3 Year Acquanted with Company 3 References Occupation 3 References Email 3 Company Address 3 Additional space is provided to expand on any points or questions asked previously in this application.
