Employment Application

Employment Application

Applicant Information

Full Name:________________________________________________ Date:________________

Last

First

Middle

Address________________________________________________________________________

Street Address

Apt./Unit #

______________________________________________________________________________

City

State

Zip Code

Home Phone:

Cell Phone:

Emergency Contact & Phone:

Email Address:

Social Security Number:

Desired Salary:

Are you able to present evidence of your U.S. citizenship and/or proof of your legal right to work in the United States? YES NO

Are you 16 year of age or older? YES NO (For employees under the age of 18, a work permit is required).

Have you ever worked for Concord Pet Foods and Supplies? If YES, when?__________________

Have you ever been convicted of a felony? YES NO

Please note: A criminal conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe your conviction including penalty imposed, listing the nature of your offense, and your rehabilitation since the conviction.

Employment Experience 1. Most Recent Employer: Employed from ______ to _____ Address: Phone: Title & Description of Responsibilities:

Reason for leaving:

2. Employer: Employed from ______ to _____ Address: Phone: Title & Description of Responsibilities:

Reason for leaving:

3. Employer: Employed from ______ to _____ Address: Phone: Title & Description of Responsibilities:

Reason for leaving:

Supervisor: Salary:

Supervisor: Salary:

Supervisor: Salary:

Pet Experience

Do you own any pets? YES NO If so, please tell us about your experience:

Have you had any special training related to pets or animals? YES NO If so, please explain:

State any additional information you feel may be helpful to us in considering your application.

Professional References

Name

Phone

Relationship

Years Known

1. ___________________________________________________________________________

2. ___________________________________________________________________________

3. ___________________________________________________________________________

Education, Training and Experience

High School: Number of years completed:

Address: Did you graduate: YES NO

Degree / diploma earned:

Describe any honors that you may have received:

College / University: Number of years completed:

Address: Did you graduate: YES NO

Degree / diploma earned:

Describe any honors that you may have received:

Other School: Number of years completed:

Address: Did you graduate: YES NO

Degree / diploma earned:

Describe any honors that you may have received:

Physical Requirements

The following information outlines specific physical requirements for employment at Concord Pet Foods & Supplies. Please review and complete the following as part of your application for employment.

I am capable of heavy lifting, sometimes up to 50 pounds. YES NO

I can stand for long periods of time (up to 12 hours).

YES NO

Do you have any physical limitations that preclude you from performing any work for which you are being considered? YES NO

If you circled "Yes" to the previous question, please explain:

Because customers are welcome to bring their pets to our stores, it is likely that you will be in close contact with these animals. Would allergies to animals, pet food and/or pet supplies prevent you from performing any work from which you are being considered? YES NO If you circled "Yes" to the previous question, please explain:

Disclaimer and Signature: I certify that all 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. This application does not constitute an employment contract. Signature:_____________________________________________________ Date:__________________

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