Part Time Job Application Name General Information What position are you interested in? Stray Dog Pickup Morning Shelter Staff First Name * Middle Inital Last Name * Address (Mailing Address) * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Phone Number * Email Address Do you have a valid driver's license? * Yes No Are you legally entitled to work in the United States? * Yes No Date Available * Education and Training High School Graduate or General Education Test (GED) Passed? Yes No College, Business School, Military (Most recent first) Name and Location Degree Did you graduate? Yes No Major/Subject Name and Location Degree Did you graduate? Yes No Major/Subject Name and Location Degree Did you graduate? Yes No Major/Subject Occupational License, Certificate, or Registration Where Issued Number Expiration Date Occupational License, Certificate, or Registration Where Issued Number Expiration Date Occupational License, Certificate, or Registration Where Issued Number Expiration Date Special Skills List any additional pertinent skills Special Skills Work Experience (Most Recent First) Employer * Phone Number * Address * Job Title * Supervisor * Began Employment * Hours Per Week * Ended Employment * Last Salary * Describe Duties * Reason for Leaving * May we contact this employer? * Yes No Employer Phone Number Address Job Title Supervisor Began Employment Hours Per Week Ended Employment Last Salary Describe Duties Reason for Leaving May we contact this employer? Yes No Employer Phone Number Address Job Title Supervisor Began Employment Hours Per Week Ended Employment Last Salary Describe Duties Reason for Leaving May we contact this employer? Yes No References Name Phone Number Relationship to you Email Address Name Phone Number Relationship to you Email Address Name Phone Number Relationship to you Email Address Resume Upload Resume * Certify I certify that the information contained in this application is true, correct, and complete. I understand that, if employed, false statements reported on this application may be considered sufficient cause for dismissal. Electronic Signature (Enter Your Name) * Date *
