Employment Application - Four Rivers Kennel

Name *

First

Last

Today's Date

Residential Address

Phone Number

Date Available

Date you are available to start working if hired

Social Security Number

Desired Salary

Desired hourly pay or annual salary in USD

Position Applied For

Are you a citizen of the United States? *

If no, are you authorized to work in the US?

Have you previously worked for Four Rivers Kennel?

If yes, when did you work here and what position?

Have you ever been convicted of a felony?

If yes, please explain:

High School Attended

Address of high school

Date Started

mm/dd/yy

Date Left

mm/dd/yy

Did you graduate?

Diploma

College, University or Post-secondary educational instition attended

Address of institution attended

Date Started

mm/dd/yy

Date Left

Final date you attended or graduated mm/dd/yy

Did you graduate from this institution?

If you graduated, what degree did you earn and in what subject?

ex: certificate program, BA, BS, MA, MS, PhD and major field of study

Professional Reference 1 Name

Professional Rererence 1 Relationship

relationship to reference- former supervisor, colleague, etc.

Professional Reference 1 Affiliation

Company or institution

Professional Reference 1 Address

Professional Reference 1 Phone Number

Professional Reference 2 Name

Professional Rererence 2 Relationship

relationship to reference- former supervisor, colleague, etc.

Professional Reference 2 Affiliation

Company or institution

Professional Reference 2 Address

Professional Reference 2 Phone Number

Professional Reference 3 Name

Professional Rererence 3 Relationship

relationship to reference- former supervisor, colleague, etc.

Professional Reference 3 Affiliation

Company or institution

Professional Reference 3 Address

Professional Reference 3 Phone Number

Previous Employer

Previous company you worked for

Address

Phone

(123)-456-7890

Supervisor

name of your supervisor at this position

Job Title:

Starting Salary

Hourly rate or annual salary when you were hired

Ending Salary

Final hourly rate or annual salary when you left this position

Responsibilities:

Briefly describe your role in this position

Start Date:

mm/dd/yy

End Date:

mm/dd/yy

Reason for leaving:

Briefly described why you left this position

May we contact your previous supervisor for a reference?

Previous Employer 2

Previous company you worked for

Address

Phone

(123)-456-7890

Supervisor

name of your supervisor at this position

Job Title:

Starting Salary

Hourly rate or annual salary when you were hired

Ending Salary

Final hourly rate or annual salary when you left this position

Responsibilities:

Briefly describe your role in this position

Start Date:

mm/dd/yy

End Date:

mm/dd/yy

Reason for leaving:

Briefly described why you left this position

May we contact your previous supervisor for a reference?

Previous Employer 3

Previous company you worked for

Address

Phone

(123)-456-7890

Supervisor

name of your supervisor at this position

Job Title:

Starting Salary

Hourly rate or annual salary when you were hired

Ending Salary

Final hourly rate or annual salary when you left this position

Responsibilities:

Briefly describe your role in this position

Start Date:

mm/dd/yy

End Date:

mm/dd/yy

Reason for leaving:

Briefly described why you left this position

May we contact your previous supervisor for a reference?

Military Service

Did you serve in the military?

Branch:

Dates Served:

Rank at Discharge:

Type of Discharge:

If other than honorable, please explain:

Disclaimer and Signature *

By entering your name and date here, you certify that your answers are true and complete to the best of your knowledge. If this application leads to employment, you understand that false or misleading information in your application or interview may result in your release from employment.