Name of Applicant:

Address:

City:

State:

Zip Code:

Home Phone: (including area code)    

Cell Phone: (including area code)     

Birth date and month

Email address:

Position applying for

Are you over 18? Yes No

Available start date

Days and hours available to work:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Were you ever discharged from a company?

Yes No

If yes, please provide the company's name and explanation:

Have you ever been convicted of a felony?

Yes No

If yes, please explain :

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

Yes No

If yes, please explain:

Have you been employed by this organization in the past?

Yes No

Education:

High School name:

Address:

Did you receive a diploma?

Yes No

Did you receive a GED?

Yes No

Graduation date (month, year):

College name:

College address:

Dates attended:

Graduation date (month, year):

Degree:

Grad school name:

Grad school address:

Dates attended:

Graduation date (month, year):

Degree:

Technical, business or other school name:

Technical, business or other school address:

Dates attended:

Graduation date (month, year):

Degree:

Employment Experience (list your present or most recent position first)

May we contact your present employer?

Yes No

Company name:

Company address:

Company phone number:

Dates of employment:

Position/Title:

Salary:

Name and title of immediate supervisor:

Reason for leaving:

Description of work:

Company name:

Company address:

Company phone number:

Dates of employment:

Position/Title:

Salary:

Name and title of immediate supervisor:

Reason for leaving:

Description of work:

Company name:

Company address:

Company phone number:

Dates of employment:

Position/Title:

Salary:

Name and title of immediate supervisor:

Reason for leaving:

Description of work:

List any special qualifications you have that you feel would be pertinent:

These statements constitute conditions of possible employment with the Cumberland Valley Animal Shelter (CVAS). For you application to be considered, it must include your signature and date at the bottom of this page.

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

- 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 authorized the references listed to release any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and released all parties from all liability for any damage that may result from furnishing same.

- 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.

- 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.

- 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.

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

- 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.

- CVAS may ask to submit an emplioyee to a drug/alchohol test.

I certify that the above statements are true and agree to the conditions of this application:
I confirm and agree.     

**Please note that by clicking the confirm and agree button and then pushing submit, you are providing the electronic equivalent of your signature.

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