APPLICATION FOR EMPLOYMENT

Personal Information

Name (Last, First, MI)

Street address

City, State, Zip

Home number/ Cell number

birthdate

Facsimile number

E-mail address

Social security number

Driver’s license number/state/expiration

Employment Desired

Position applied for and desired pay?

How did you hear about this position?

Date available for work

Desired hours (full time, part time, etc.)

Education

Name and Address of School

Course of

Study

Years of Study

Degree/

Diploma

High

School

Today’s Date:

Undergraduate College

Graduate/

Professional

Other

(Specify)

List any seminars, classes or other education not listed above which may help qualify you for a position at Indian Shoals Pet Resort (if you need additional space, please use page 7):

Employment Application

Employment History

List below all present and past employers over the past ten years, starting with your most recent employer.  Account for all periods of unemployment.  You must complete this section even if attaching a resume.

1.

Employer

Start

Date

End

Date

Work performed

Address

City, State, Zip

Starting

Salary

Ending

Salary

Phone number

Fax number

E-mail address:

Job title

Supervisor

Reason for leaving

What value did you add to this company or its customers?

2.

Employer

Start

Date

End

Date

Work performed

Address

City, State, Zip

Starting

Salary

Ending

Salary

Phone number

Fax number

E-mail Address

Job title

Supervisor

Reason for leaving

What value did you add to this company or its customers?

Employment Application

Employment History

3.

Employer

Start

Date

End

Date

Work performed

Address

City, State, Zip

Starting

Salary

Ending

Salary

Phone number

Fax number

E-mail address:

Job Title

Supervisor

Reason for leaving

What value did you add to this company or its customers?

4.

Employer

Start

Date

End

Date

Work performed

Address

City, State, Zip

Starting

Salary

Ending

Salary

Phone number

Fax number

E-mail address

Job title

Supervisor

Reason for leaving

What value did you add to this company or its customers?

Employment Application

Additional Information

List any professional, trade, business or civic activities and offices held.  You may exclude any membership that would reveal gender, race, religion, national origin, ancestry, age, disability or any other protected status.

 _______________________________________________________________________

List any languages other than English that you can speak, read or write:

Speak

Read

Write

Please identify any specific animal or pet related experience that you have.

Identify what skills you possess that make you most suited for the position applied for on this application:

Explain how, if you are hired, you plan to add value to Indian Shoals Pet Resort:

Identify what you believe are the most unique features of Indian Shoals Pet Resort:

Employment Application

Skills and Qualifications Information     (Please check yes or no)

Have you ever been employed with this company before?

O Yes

O No

If Yes, when?

Do you have any friends or relatives employed by this company?

O Yes

O No

If yes, please provide their names and relationship to you:

Are you currently employed?

O Yes

O No

May we contact your employer?

O Yes

O No

Are you currently on “lay off” status and subject to recall?

O Yes

O No

If you are under 18 years of age, can you provide proof of your eligibility to work in the U.S.?

O Yes

O No

If hired, can you provide proof of U.S. citizenship or proof of your legal right to live and work in this country?

O Yes

O No

Are you able to perform the essential functions and duties of the job for which you are applying? (lifting 50+ lbs, walking for long periods etc.)

O Yes

O No

If not, please describe the functions or duties you are unable to

perform:

If hired, are there any accommodations the company would need to provide so that you can perform all those essential functions and duties of the position being applied for?

O Yes

O No

If Yes, please explain:

Have you been convicted of a felony within the last 7 years?

O Yes

O No

If Yes, please explain:

If hired, would you have a reliable means of transportation to and from work?

O Yes

O No

If hired, would you be able to travel and work overtime as needed?

O Yes

O No

Have you ever been treated for work related injuries by a doctor? If yes, please explain:

O Yes

O No

Do you understand that All holidays, Summer, and weekends (Spring Break, Memorial Day thru August 8^th,Labor Day ,Thanksgiving, Dec 20th thru Jan 8^th are MANDITORY WORK PERIODS. Failure to work during these times if assigned will result in termination of your position. These dates are critical and someone will be hired to fill your position should you fail to work without prior approval in writing from your manager.

Do you understand that excessive tardiness ( more than one time in  a two week period can result in termination)

Do you understand that failure to show up for your assigned work day without calling your manager will be grounds for immediate termination?

Texting is NOT acceptable.

Do you understand that any use of Tobacco, Alcohol or non prescribed drugs while on premises will result in immediate termination?

Do you understand that slander against Indian Shoals or any other employee will be grounds for termination?

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Employment Application

References

List below three persons not related to you who have knowledge of your work performance within the last 5 years.

Name

Occupation

Company name

Address

Telephone

E-mail

Years acquainted

Name

Occupation

Company name

Address

Telephone

E-mail

Years acquainted

Name

Occupation

Company name

Address

Telephone

E-mail

Years acquainted

Additional Space

Additional space is provided to expand on any points or questions asked previously in this application.

Employment Application

Applicant’s Statement

Please read each paragraph closely, initial each, and sign below

_____

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge.  I further certify that I, the undersigned applicant, have personally completed this application.  I understand that any omission or misstatement of material fact on this application or any other document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

_____

I hereby authorize the Company to thoroughly investigate my references, work records, education, driving record, credit history, criminal background and other matters related to my suitability for employment.  I further authorize the employers, schools and other references I have listed to disclose to the company any and all documents, transcripts, letters, reports and other information related to these references, without giving me prior notice of such disclosure.  I further authorize an investigative consumer report from an agency such as Equifax and will sign a release to that effect.  I hereby release the Company, my former employers, and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosures.

_____

I hereby agree to submit to binding arbitration all disputes and claims arising out of the submission of this application.  I further agree, in the event that I am hired by the Company, that all disputes which might arise out of my employment with the Company and cannot be resolved by informal internal procedures, whether during of after employment, be submitted to binding arbitration.  Said disputes and claims include but are not limited to those involving a violation of civil rights, sexual harassment, discrimination, and wrongful termination.  I agree that such arbitration shall be conducted under the rules of the American Arbitration Association in the county in which the Company’s primary place of business is located.  I understand as a condition of employment that I may be required to enter into a stand alone arbitration agreement.

_____

I understand that nothing contained in the application, or conveyed during any interview which may be granted, or during my employment, if hired, is intended to create an employment contract between me and the Company, other than one that is “at will.”  I understand and agree that if I am employed, my employment will be of an “at will” nature, whereby either the employee or the employer may terminate the employment relationship at any time, with or without cause or notice.  I further understand that my employment, if hired, is for no definite or determinable period of time and may be terminated at any time, at the option of either myself or the Company, and that no promise or representation contrary to the foregoing is binding on the company unless made in writing and signed by me and the company’s designated representative.

_____

If offered a position with the Company, I hereby agree to any physical, psychological, skill, drug or medical test required by the Company as a condition of employment.

Employment Application

Policy Statements

Please read each paragraph closely and initial each and sign below

Equal Employment Opportunity Statement

_____

This company is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit.  We are committed to complying with all Federal, State and local laws providing equal employment opportunities, as well as all laws related to terms and conditions of employment.  The Company desires to keep a work environment which is free of sexual harassment and discrimination due to race, religion, color, national origin, sexual orientation, physical or mental handicap, marital status, age or any other status protected by Federal, State or local laws.  We are willing to employ individuals of both sexes, of all ethnic and racial groups, and all ages permissible by law, and representing a broad spectrum of religions and national origins.  The Company will make every reasonable effort to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.

Discrimination and Sexual Harassment Policy Statement

_____

This company will not tolerate any form of discrimination, including sexual harassment.  Any employee who engages in discrimination or sexual harassment will be investigated by this company and subject to appropriate discipline, up to and including termination.

Prohibited sexual harassment is defined as follows: Unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature constitutes sexual harassment when (1) submission to such conduct is made whether explicitly or implicitly a term or condition of an individual’s employment; (2) Submission to or action of such conduct by an individual is used as the basis for employment decisions affecting such individuals; or (3) Such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile or offensive work environment.

Disclosure to Applicants Concerning Drug/Alcohol Testing

_____

If you are offered a position with the Company you may be given a drug/alcohol test as a condition of employment.  Your refusal to submit to a drug/alcohol test or failure to pass such a test means you will not be employed by this company.  Drug testing will be conducted in a manner that affords maximum privacy to the individual being tested.  Neither the collector of specimens nor the medical professional who reviews the test results will be a company employee.  The test results will be kept confidential.  The individual undergoing testing will not be directly observed while providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen.  Negative test results are required as a condition of employment.  I understand I will have the opportunity to explain any positive results.

I HAVE READ THE ABOVE POLICY STATEMENTS, UNDERSTAND THEM AND AGREE TO BE BOUND BY THEM IF EMPLOYED BY THIS COMPANY.

Signature

Date