HSSV Application for Employment – Humane Society of Skagit Valley (HSSV)

Personal Information

Position Information

Education

Previous Employment #1

Previous Employment #2

Previous Employment #3

References

Acknowledgement

First Name

Last Name

Phone

Street Address

City

State

Zip Code

Referred By

Position Desired

Date you can start

Salary Desired

Have you ever applied for employment with HSSV in the past?

Yes No

If so, when?

Do you have a high school diploma or GED?

Yes No

Name and Location of High School

Did you attend college/trade school or are you presently enrolled in college/trade school?

Yes, I graduated with a degree. No, I have never attended college or trade school. I am currently enrolled in college/trade school.

Name of degree obtained or in process:

Name and location of college/trade school:

Name of Previous Employer:

Street Address of Previous Employer:

City

State

Zip Code

Date Started:

Date Ended:

Position Held:

Reason for Leaving:

Supervisor Name

Supervisor Phone

Ok to Contact?

Yes No

Name of Previous Employer:

Street Address of Previous Employer:

City

State

Zip Code

Date Started:

Date Ended:

Position Held:

Reason for Leaving:

Supervisor Name

Supervisor Phone

Ok to Contact?

Yes No

Name of Previous Employer:

Street Address of Previous Employer:

City

State

Zip Code

Date Started:

Date Ended:

Position Held:

Reason for Leaving:

Supervisor Name

Supervisor Phone

Ok to Contact?

Yes No

Reference #1

Reference #1 Telephone

Reference #1 Email

Relationship to Reference #1

Reference #2

Reference #2 Telephone

Reference #2 Email

Relationship to Reference #2

Do you have any experience working with animals? If so, please explain below.

What interests you about working for The Humane Society of Skagit Valley?

Many positions within HSSV require the ability to lift 50+ lbs or more. Would you be able to do that?

Yes, I can safely lift Fifty plus lbs as needed. No, I am not able to lift Fifty plus lbs.

There is a 30 day probationary period for all positions within HSSV. Please check the box below to indicate that you understand and agree to that probationary period, should you be offered a position with us.

I understand that there is a 30-day probationary period for all positions within HSSV.

By clicking below, I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize the investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not premit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

I agree to the above statement.

Type your full name below for an electronic signature:

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