Employment Application Application – Employment Type of work you are interested in * Float Full-Time Part-Time Volunteer Check all that apply. Name * Name First First Middle Middle Last Last Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Address Primary Phone Number * Secondary Phone Number Email Address * Former Name(s) Maiden name, previous name before a name change, etc. Date of Birth * Do you possess a valid driver’s license? * No Yes Drivers License Number * If you have a CDL, please list classification Are you a U.S. Citizen or do you have an entry permit which allows you to work? * No Yes Note: If you were born outside the United States, you may be asked to submit evidence of citizenship (or intent to become a citizen). Did you serve in the U.S. Armed Forces? * No Yes Armed Forces History Include dates and rank Have you ever been convicted of a criminal offense that is relevant to the duties of this position (e.g., animal cruelty, violence, theft, or fraud)? A conviction will not automatically disqualify you from employment. If yes, please provide details. * No Yes Please explain: Visual Code Conviction record will not automatically exclude you from employment. Factors such as age at the time of the offense, rehabilitation efforts, and time passed and seriousness of the crime will be taken into account. The relationship between the offense and the job for which you are applying will be evaluated carefully. Emergency Contact Person, other than yourself, who we may contact in the event of an emergency. Name * Name First First Last Last Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Address Phone * Email Upload your resume and cover letter if applicable Drop a file here or click to upload (Word or PDF only). Choose File Maximum file size: 33.55MB Upload a resume, cover letter, and references. If you have provided a resume and references, you may skip the following sections and submit your application now. Education History Complete this section only if the information has not been included in the attachments upload. School Name School City/State Number of Years Attended Degree Studied High SchoolAssociate'sBachelor'sMaster'sDoctorate Graduated No Yes plus1 Add minus1 Remove Employment History Complete this section only if the information has not been included in the attachments upload. Company Name Start Date MM/YY End Date MM/YY Ok to contact? No Yes Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Address Supervisor’s Name Supervisor's Name First First Last Last Supervisor’s Title Supervisor’s Phone Position Title Reason For Leaving Number of Employees Supervised Salary Frequency HourlyMonthlyAnnually Position Type Full-timePart-timeOther Duties Performed plus1 Add minus1 Remove References Complete this section only if the information has not been included in the attachments upload. Name * Name First First Last Last Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Address Phone * Business/Occupation * plus1 Add minus1 Remove Other Complete this section only if the information has not been included in the attachments upload. Additional skills, machines or office equipment you can operate Visual Code Include competency level for equipment/machines Captcha Submit If you are human, leave this field blank. By submitting this form, I certify that: All statements on my application materials are complete and true to the best of my knowledge. I understand that false statements or omissions of fact shall be sufficient cause for rejection of this application or dismissal, if I am not an employee of the South Wood County Humane Society (SWCHS) I understand that, if I am employed such employment does not create a contractual obligation upon the SWCHS to continue my employment and that I may be terminated, with or without cause and with or without notice, at any time. The SWCHS is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability, veteran status, or any other protected group. I grant permission to the SWCHS to conduct a criminal background check and investigate my reference, to include past employers listed; and I authorize my references and past employers to provide the SWCHS information which SWCHS deems appropriate.
