Employment Application - Jersey Shore Animal Center

Today's Date*

Name*

First Middle Last

Date of Birth*

Social Security #*

Driver's License #*

If you do not have a driver's license, please put N/A

Address*

Street Address Address Line 2 City State ZIP Code

Home/Cell Phone #*

Email*

What position are you applying for?*

Salary desired?*

Have you ever worked or attended school under another name?*

Yes
No

If yes, state dates and name(s):

Have you ever worked for JSAC?*

Yes
No

If yes, when and what position?

Do you have any relatives employed with JSAC?*

Yes
No

If yes, name:

Are you at least 18 years or older?*

Yes
No

Do you experience any allergies to animals?*

Yes
No

If yes, to what/how bad?

Are you willing to work Holidays and Weekends?*

Yes
No

If no, please explain:

If applicable, are you available to work overtime?*

Yes
No

Days/Hours you're available to work:*

Select All
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

If offered employment, when would you be available to begin work?*

Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?*

Yes
No

If no, what reasonable accommodation, if any, would you request?

Are you a citizen of the USA or lawfully admitted resident alien?*

Yes
No

Education

Education*

High School
Associate Degree
Bachelor's Degree
Graduate or Professional Degree
Some College
Other
Prefer Not to Answer

Please check all that apply

Name and Location of School(s), Years Attended and Course, Major or Degree*

Please put N/A if this does not apply

Prior Work History

List in Order: Present Employer First

Name of Employer #1

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Supervisor Name and Title

Dates of Employment

ex: April 1, 2010 to June 30, 2018

Rate of Pay: Start and Finish

Briefly describe your job duties, include job title:

Reason for Leaving

Name of Employer #2

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Supervisor Name and Title

Employed: From - To

Rate of Pay: Start/Finish

ex: $8.50/$10.00

Briefly describe your job duties, include job title:

Reason for Leaving

Upload Resume

files accepted: pdf, doc, docx, jpeg

If currently employed elsewhere, do you expect to continue with that employment?*

Yes
No

Please explain:

Please list any volunteer or civic activities that you are part of:

Other experiences(s), skills/hobbies you would like to mention:

Why do you want to work at the JSAC?*

List at LEAST two (2) Personal References that are not relatives or former employers:*

List Name, Address, phone number and years known

In Case of Emergency notify:

Name, Phone Number, Address and Relationship

Consent*

I agree to the privacy policy.

I agree and understand that all the statements and information on my application are correct and no attempt has been made to conceal or withhold pertinent information. I agree that any omission, falsification, or misrepresentation is cause for immediate termination at any time during my employment.

I hereby authorize investigation of all statements at this time with no liability arising therefrom. I will abide by all rules, regulations and policies of the JSAC.

A the option of the company, I agree to physical examination by a physician chosen by the JSAC with the understanding that my employment at depends upon passing the physical.

I understand that by completing this application, it is not an offer of employment or contract and that, if hired, employment will be "at will" and subject to termination at any time for any reason.

I further understand that a 90 day working probationary period will be in effect in the event employment is offered. This is not a guaranteed employment time frame; it is a period during which I may be terminated at anytime with our without cause.

Name

This field is for validation purposes and should be left unchanged.