Avon Lake - Employment Application Form

1
APPLICANT INFORMATION
Last Name
First Name
M.I.
Date
Street Address
Apartment/Unit #
City
State
2
ZIP
Phone
E-mail Address
Date Available
Social Security No.
Desired Salary
3
Position Applied for
Hours available for work
Requested hours per work
4
Please Select
Please Select
Yes
No
Are you a citizen of the United States?
Please Select
Please Select
Yes
No
If no, are you authorized to work in the U.S.?
Please Select
Please Select
Yes
No
Have you ever worked for this company?
If so, when?
Please Select
Please Select
Yes
No
Have you ever been convicted of a felony?
If yes, explain
5
EDUCATIONHigh School
High School
Address
From
To
Please Select
Please Select
Yes
No
Did you graduate?
Degree
6
EDUCATIONCollege
College
Address
From
To
Please Select
Please Select
Yes
No
Did you graduate?
Degree
7
EDUCATIONOther
Other
Address
From
To
Please Select
Please Select
Yes
No
Did you graduate?
Degree
8
REFERENCE #1
Full Name
Relationship
Address
Phone
9
REFERENCE #2
Full Name
Relationship
Address
Phone
10
REFERENCE #3
Full Name
Relationship
Address
Phone
11
PREVIOUS EMPLOYMENT #1
Company
Phone
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
12
From
To
Reason for Leaving
Please Select
Please Select
Yes
No
May we contact your previous supervisor for a reference?
13
PREVIOUS EMPLOYMENT #2
Company
Phone
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
14
From
To
Reason for Leaving
Please Select
Please Select
Yes
No
May we contact your previous supervisor for a reference?
15
PREVIOUS EMPLOYMENT #3
Company
Phone
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
16
From
To
Reason for Leaving
Please Select
Please Select
Yes
No
May we contact your previous supervisor for a reference?
17
Have you had any experience-handling animals? If, so describe briefly
18
DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
19
Signature
Clear
20
Date
Date
Year
Month
Day
Should be Empty: