Employment Application – Behavior Associate – Heart of the Valley Animal Shelter

Last Name *

First Name *

Middle

Address *

Address

City

State/Province

Zip/Postal

Phone *

Email *

Have you ever been convicted of a crime? (Exclude minor traffic infractions. DUI’s must be noted.) *

Yes

No

If yes, please explain and list the date of the conviction:

Are you prevented from lawfully being employed in the country because of Visa or Immigration status? (Proof of citizenship will be required upon employment.) *

Yes

No

Position Desired: *

Please choose one of the following: *

Full Time

Part Time

Date available to begin work: *

Are you willing to work weekends? *

Yes

No

Expected rate of pay: *

How did you hear about this job? *

Please list friends and relatives in our employment: *

Were you previously employed with Heart of the Valley? *

Yes

No

If yes, when?

Employment History: (Please include any relevant volunteer experience.)

Employer

Address

Phone

Job Title

Pay Rate

Dates of your employment:

Describe your job:

Reason for leaving:

Employment History:

Employer: *

Address: *

Phone: *

Job Title *

Pay Rate *

Dates of your employment: *

Describe your job: *

Reason for leaving: *

Add Remove

Education/ Skills:

Last High School Name and Address: *

Grades completed: Did you graduate? *

College/Trade School Name and Address:

Years Completed: Did you graduate?

Courses Studied:

College/Trade School Name and Address:

Years Completed: Did you graduate?

Courses Studied:

Other courses, trade certificates or studies:

Name and Address of Organization:

Course Certification (if any):

Dates of Attendance:

Add Remove

Professional References:

Professional References: Please list 3

Name

Affiliation

Phone

Years Known

Professional References:

Name

Affiliation

Phone

Years Known

Professional References:

Name *

Affiliation *

Phone *

Years Known *

Add Remove

Statement of Interest:

Write a brief sentence or two on why you would be a good candidate for this job: *

Employment Requirements:
 Ability to work at a computer.
 Be on time for scheduled hours.
 Courteous customer service to all clients at all times.
 Able to lift 50 lbs unaided and safely.
 Able to work with dogs and cats.
 Ability to work with various personalities and get along with all staff members.
 Considerate of volunteers and respectful of their compassion.
 Ability to withstand loud noises, odors, animal hair, and dander.
 Physical ability to stand on hard floors for extended periods of time.
 Able to withstand the physical stress of bending and stooping continually.
 Able to follow direction given by supervisors.

Initial here that you understand these requirements: *

IMPORTANT
PLEASE READ THE FOLLOWING CONDITIONS OF EMPLOYMENT
Your signature below indicates you have read and agree to the following
conditions:
I certify that the information contained in this application is true and complete. I
understand that providing false or misleading information, misrepresentation or
willful omission of facts during the application or interview process may result in
withdrawal from consideration for employment or immediate discharge if already
hired, regardless of when discovered. I authorize Heart of the Valley, Inc. to
investigate all statements in this application and to conduct a thorough
investigation of my past employment, education and job related activities. I
indemnify HOV against any liability which may result from conducting such an
investigation. All employers, educational institutions and references listed are
hereby authorized to give you any and all information regarding my employment
and character and are hereby released from any and all liability which may result
from furnishing such information.
By signing the acknowledgement that I am 18 years of age or older and am
physically able to perform the duties mentioned above, I am also signing that I
understand and accept that Heart of the Valley, Inc. is a Drug Free Workplace. I
understand that as a condition of employment I may be asked to submit to a
urinalysis or blood test at the expense of Heart of the Valley, Inc. This test may
test for drugs such as, but not limited to, cannabinoids, cocaine, opiates,
amphetamines, phencyclidine, barbituates, methaqualone, benzodiazepines,
methadone, propoxyphene, and any other substance illegal under federal or state
law. The drug test will be performed by a reputable drug testing company or
hospital. The results of the test will remain confidential and will not be disclosed
to anyone other than you, Heart of the Valley, Inc., and the person and/or entity
conducting the test. If your test results are positive for any of the drugs
referenced above, Heart of the Valley reserves the right to not hire you.
Updated 11/2018
I understand that personal property carried by me to and from Heart of the Valley
Animal Shelter may be inspected by an authorized Heart of the Valley
representative.
I understand this application is not a contract of employment.

Would you like to include a Resume or Cover Letter?

Maximum file size: 4MB

Signature *

Date *