Name (include first, last and middle initial)

Have you ever been referred to under another name?
  Yes                       No

If yes, what was the name?

Address:

City:    State:    Zip Code:

Home Phone: (including area code)     

Cell Phone: (including area code)       

Position applying for: (be specific) 

Salary Expected: 

Type of Employment:
  Full Time           Part Time         Temporary        Nights

Times available for work each day:

Sunday:

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:
 

Do you have a valid driver's license?   Yes        No       Class: 

Are you under 18?    Yes        No

How were you referred to us?

   Advertisement         Employment Agency      CVAS Employee      Walk-in

  Friend or Relative 

Name of Employment Agency:  

Contact's Name: 
 

TWO REFERENCES (Do not list relatives or former employers):

Name:

Address:

City:    State:    Zip Code:

Phone: (including area code)    

Years known: 

Name:

Address:

City:    State:    Zip Code:

Phone: (including area code)    

Years known: 

Were you ever discharged by any company?     Yes          No

If yes, what was the name of the company(s):

Have you ever been convicted of any felonies or misdemeanors?     Yes          No

If yes, please explain offense and final disposition:

**(The existence of a criminal conviction does not constitute an automatic bar to employment and factors such as seriousness of the crime and any rehabilitation will be taken into account.)

Have you ever been convicted of a criminal offense other than a minor traffic violation? A conviction includes a plea, verdict, or guilty finding regardless of whether sentence was imposed by the court.

  Yes        No

If yes, please explain:

** (Disclosure of a criminal record will not necessarily disqualify you for employment. Each conviction of a guilty plea will be evaluated on its own merit with respect to time, circumstances and seriousness in relation to the job for which you are applying. However, failure to disclose such information may result in disqualification of your application or termination of employment.)
 

Please list any special qualifications you have:

EDUCATION (please include all applicable information):

High School:

City and State: 

Received diploma?     Yes          No        Received GED?      Yes       No

Graduation date:  (month and year)  

Secondary Education:

College: 

City and State: 

Degree: 

Major:      Minor: 

Dates attended: 

Did you graduate?      Yes       No         Month/Year: 

GPA: 
 

College: 

City and State: 

Degree: 

Major:      Minor: 

Dates attended: 

Did you graduate?      Yes       No         Month/Year: 

GPA: 

EMPLOYMENT EXPERIENCE (List your present or most recent position first)

May we contact your present employer?        Yes          No

Company Name:

Address:

Phone Number: (including area code)    

Dates of Employment:  From     To

Position/Title:

Salary:  Start   Finish

Name and Title of Immediate Supervisor:

Reason for leaving:

Description of Work:

Company Name:

Address:

Phone Number: (including area code)    

Dates of Employment:  From     To

Position/Title:

Salary:  Start   Finish

Name and Title of Immediate Supervisor:

Reason for leaving:

Description of Work:

Company Name:

Address:

Phone Number: (including area code)    

Dates of Employment:  From     To

Position/Title:

Salary:  Start   Finish

Name and Title of Immediate Supervisor:

Reason for leaving:

Description of Work:

APPLICANT STATEMENT

Please read the following statements carefully before hitting the submit button. Clicking the submit button is the electronic equivalent of your signature and will be considered as such.

These statements constitute conditions of possible employment with the Cumberland Valley Animal Shelter (CVAS). For your application to be considered, you must click the "I confirm and agree" button below before hitting submit.

If you do not understand any of the provisions of this application, please call (717) 263-5791 during business hours for further clarification.

1.  I certify that the statements made in this application are true and correct to the best of my knowledge. I understand that falsification of this information or any material omission could result in dismissal of this application or termination of my employment. Permission is hereby granted to obtain verification of the statements made herein and to contact the  references I furnished. I authorize the references listed to release any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same.

2.  I understand as a condition of employment with CVAS, certain shelter areas and issues will remain confidential, such as client, customer and cruelty information and will hold all details in that regard.

3.  I understand that although reasonable efforts will be made to accommodate individual preferences, business needs may make the following conditions mandatory: over-time, shift work, a rotating work schedule, or a work schedule that includes weekends and holiday work.

4.  I understand that if I am hired by CVAS, my employment will not be for a definite duration and can be terminated at any time by either myself or CVAS. I further understand that none of CVAS's personnel policies should be construed as a contract of guarantee of continued employment. No representative of CVAS or any of its affiliates, other than the CVAS board of directors and/or president has authority to enter into an agreement for employment for any specific period of time or to approve any agreement contrary to the foregoing.

5.  In completing this application of employment, I understand that research and discussion may be made regarding criminal convictions, educational records and references I have released in the above document. That inquiry could include information regarding my character, general reputation and personal characteristics.

6.  CVAS is committed to providing a safe working environment. I further understand the sale, use, possession, purchase, transfer, or manufacture of alcohol and/or illegal drugs on CVAS premises or while on company business is prohibited, and is grounds for immediate termination.

I certify that the above information is true to the best of my knowledge and I agree to the six statements as listed above.

  I confirm and agree