Employment Application

Employment Application for Lucy Mackenzie Humane Society

Lucy Mackenzie Humane Society Employment Application - to be completed by all individuals interested in applying for employment.

Position you are applying for:
APPLICANT INFORMATION
Name
First Middle Last
Mailing Address
Mailing Address Address Line 2 City State ZIP Code
Physical Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Social Security Number
Date Available to Begin
Are you a citizen of the United States?
If no, are you authorized to work in the US?
Have you ever worked for Lucy Mackenzie Humane Society?
If yes, when?
Have you ever been convicted of a felony?
If yes, please explain.
EMPLOYMENT HISTORY
Beginning with either your current or most recent, please complete the details of your three most recent places of employment.
1. COMPANY NAME
Address
Street Address Address Line 2 City State ZIP Code
Phone
Supervisor's Name
Job Title
Starting Salary
Ending Salary
Responsibilites
Start Date
End Date
What was your reason for leaving this position?
2. COMPANY NAME
Address
Street Address Address Line 2 City State ZIP Code
Phone
Supervisor's Name
Job Title
Starting Salary
Ending Salary
Responsibilites
Start Date
End Date
What was your reason for leaving this position?
3. COMPANY NAME
Address
Street Address Address Line 2 City State ZIP Code
Phone
Supervisor's Name
Job Title
Starting Salary
Ending Salary
Responsibilites
Start Date
End Date
What was your reason for leaving this position?
EDUCATION
Name of High School
High School Address
Dates Attended
Did you graduate high school?
Name of College
College Address
Dates Attended
Do you have a degree?
What is your degree in?
Education - Other
Please detail any other types of education or certificates.
GENERAL
Please describe your work experience with animals:
Do you have any allergies?
If yes, please explain:
Why would you like to work at Lucy Mackenzie?
Are you able to life 50 lbs. safely and unaided?
Do you currently have any animals of your own?
If yes, how many and what types?
All employees are expected to work some holidays and to fill in as needed. Please check the box below indicating you agree to this requirement.
- I understand that I will be required to work some holidays.
REFERENCES
Please list three references below, including at least two professional relations.
First Reference Name
Phone
Relation
Years known?
Second Reference Name
Phone
Relation
Years known?
Third Reference Name
Phone
Relation
Years known?
DOCUMENT UPLOADS
If you would like to upload a cover letter, resume, or any other documents, please do so here.
Disclaimer and Signature - Please Read Carefully
I hereby certify, under the penalty of perjury, that this application contains no willful misrepresentations and that the information is true and complete to the best of my knowledge. I know that if investigation at any time should disclose misrepresentation of falsification or omission that my application will be rejected or I may be discharged from my employment should I become an employee of LMHS.
By entering your name here, you agree to the above statement.
First Last
Date
Date Format: MM slash DD slash YYYY

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Employment Application

Employment Application for Lucy Mackenzie Humane Society

APPLICANT INFORMATION

EMPLOYMENT HISTORY

EDUCATION

GENERAL

REFERENCES

DOCUMENT UPLOADS

Disclaimer and Signature - Please Read Carefully