Address

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Applicant Information

Full Name:____________________________________________________ Date:_____________________ Address:________________________________________________________________________________ _______________________________________________________________________________________

Home Phone:

Cell Phone:

Emergency Contact:

Email Address:

Social Security Number:

Desired Salary:

Availability Mon__________Tues__________Wed__________Thurs__________Fri_________Sat__________Sun__________ Are you able to present evidence of your U.S citizenship and/or proof of your legal right to work in the Unites States? YES NO Are you 16 year of age or older?

YES NO (For employees under the age of 18, a work permit is required)

Have you ever been convicted of a felony? YES NO

Please note: A criminal conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe your conviction including penalty imposed, listing the nature of your offence, and your rehabilitation since the conviction.

Employment Experience 1. Most Recent Employer: Employed from____________to____________

Supervisor:

Address: Phone:

Salary:

Title & Description of Responsibilities:

Reason for leaving:

2. Most Recent Employer: Employed from____________to____________

Supervisor:

Address: Phone:

Salary:

Title & Description of Responsibilities:

Reason for leaving:

3. Most Recent Employer: Employed from____________to____________

Supervisor:

Address: Phone:

Title & Description of Responsibilities:

Reason for leaving:

Salary:

Pet Experience Do you own any pets? YES

NO

If so, please tell us about your experience:

Have you had any special training related to pets or animals? YES NO

State and additional information you feel may be helpful to us in considering your application.

Professional References Name

Phone

Relationship

Years Known

1.______________________________________________________________________________________ 2.______________________________________________________________________________________ 3.______________________________________________________________________________________ Education, Training and Experience High school:

Address:

Number of years completed:

Did you graduate: YES

NO

Degree/diploma earned: Describe any honors that you may have received:

College/University:

Address:

Number of years completed:

Did you graduate: YES NO

Degree/diploma earned:

Describe any honors that you may have received: Other School: Number of years completed:

Address:

Degree/diploma earned:

Did you graduate: YES NO

Describe any honors that you may have received:

Physical Requirements The following information outlines specific physical requirements for employment at Garoppo's Feed & Pet Supplies. Please review and complete the following as part of your application for employment.

I am capable of heavy lifting, sometimes up to 50 pounds. I can stand for long periods of time (up to 10 hours).

YES YES

NO NO

Do you have any physical limitations that preclude you from performing any work for which you are being considered? YES NO If you circled "YES" to the previous question, please explain:

Because customers are welcome to bring their pets to our stores, it is likely that you will be in close contact with these animals. Would allergies to animals, pet food, and/or pet supplies prevent you from performing any work from which you are being considered? YES NO Disclaimer and Signature: I certify that all my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. This application does not constitute and employment contract.

Signature:_______________________________________________________Date:___________________