Lawrence, KS   785-550-1427     

Online Employment Application

Position applying for:
First Name:
Middle Initial:
Last Name:
Address(include Apartment/unit#):
City:
State:
Zip:
Phone:
E-Mail:
Do you own a car? Yes No
Car Year, Make, Model:
Are you a citizen of the United States? Yes No
If no, are you authorized to work in the U.S.? Yes No
Have you ever worked for this company? Yes No
If yes, when?
Have you ever been convicted of a criminal offense? Yes No
If yes, explain:

Education

High School:
Address:
From: To:
Did you graduate? Yes No
Diploma:
College:
Address:
From: To:
Did you graduate? Yes No
Degree:
Other:
Address:
From: To:
Did you graduate? Yes No
Degree:

References
Please list three professional references.

Full Name: Relationship:
Company: Phone:
Address:
Full Name: Relationship:
Company: Phone:
Address:
Full Name: Relationship:
Company: Phone:
Address:

Previous Employment

Company: Phone:
Address: Supervisor:
Job title:     Starting Salary: $     Ending Salary: $
Responsibilities:
From:     To:     Reason for leaving:
May we contact your previous supervisor for a reference? Yes No

Company: Phone:
Address: Supervisor:
Job title:     Starting Salary: $     Ending Salary: $
Responsibilities:
From:     To:     Reason for leaving:
May we contact your previous supervisor for a reference? Yes No

Company: Phone:
Address: Supervisor:
Job title:     Starting Salary: $     Ending Salary: $
Responsibilities:
From:     To:     Reason for leaving:
May we contact your previous supervisor for a reference? Yes No

Additional Experience
Please list any volunteer or othe relevant experience you may have in the handling, care or training of dogs or other animals.


Military Service

Branch:     From:     To:
Rank at Discharge:     Type of Discharge:
If other than honorable, explain:

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.

By submitting this form, I authorize the employer or his agents to procure such credit, rental, employment, or criminal information; or other information regarding my general character, reputation, or mode of living; as they may deem necessary to verify my statements herein, or to ascertain to their satisfaction my qualifications and fitness as an employee; and I release all agencies, government entities, companies or individuals to provide such information to the employer or his agents.

Signature: