Application for Employment For your application to be accepted, all areas must be completed no matter what position you are applying for. All driving information must be filled out your signature must be filled out in all required areas. All references will be checked Driving records and criminal background checks will be done. This is a drug free work place and an equal opportunity employer. If you have any questions please ask the receptionist, or call (352)-567-9453 Thank you.
Application for Employment Signature of Applicant Date Print Name Phone Number Social Security #: Drivers License #: Current Address Previous Address (if less then 3 years) Email Address? Position Applying for Desired Rate of Pay Who Referred You? Have You Worked for this Company? if YES to Reason for Leaving Names of Relatives working for this Company? Are you currently Employed? if YES where? Highest Grade Completed? (circle) High School College
GENERAL QUESTIONS Have you ever been Bonded? Name of Bonding co. Have you ever been convicted of a felony? If yes, please explain Have you ever used another name? Are you taking any medications? please list Are you allergic to any medications? Are you under doctor s care? Reason? Name of Physician? Phone Number Name of Emergency Contact Person Phone: Work Cell Relationship Do you have a current drivers license? State Have you ever been arrested for a DUI? When? Have you ever been denied a license? Why?
Employment Record Start with current employer and work back NOTE: Job Only no volunteer work Current Employer: Reason For Leaving: Company: Reason For Leaving: Company: Reason For Leaving: Company: Reason For Leaving: Company:
Reason For Leaving: Clerical Experience & Qualifications List Courses and Training in Office: List training and experience in the following: Filing: Calculators: Photocopiers: Book Keeping: Internet: Comments:
Driving Experience Drivers License held in the last 3 years: Endorsements: Restrictions: Health Card Effective dates to Have you ever been denied a license or permit to operate a motor vehicle? Has any license or permit been suspended or revoked? If yes, explain: Accident Review for the past 3 years: Last accident: Next previous: Next previous: List any types of heavy equipment operated:
Dade City s Wild Things Employment Verification Form, SS# (SIGNATURE) Has applied for employment with Dade City s Wild Things. Please provide the follow information which will assist Dade City s Wild Things in completing our applicant screening process. Dade City s Wild Things appreciates your assistance in the matter. Authorization I hereby authorize the above referenced individual, company or institution to furnish Dade City s Wild Things with the information requested now, which they have on record, or otherwise and hereby do release the above referenced employer and Dade City s Wild Things from all liability for any damage whatsoever incurred when furnishing information. Applicant s Signature: Excellent Good Satisfactory Marginal Poor Performance Attendance Reliable Attitude (For former Employer, not Applicant) Dates of employment: What was the job description?: Would you rehire? If no, why? Quit or Fired? Reason for leaving?: Representiative s Signature: Printed Name: Title: Date:
APPLICANT MUST READ AND SIGN I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his/her agents may investigate my background to ascertain that any and all information of concern to my employment history. Whether same is of recorded or not and I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that as an application for a position with this company I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be condition on the results of a physical examination and drug test. This company also condition employment of a 90 day probation period. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. It is also agreed and understood that under the Fair Credit Reporting Act, Public 91-508, I have been told that this investigation may include and Investigate Consumer Reporting, including information regarding my character, general reputations, person characteristics and mode of living. I agree to furnish such additional information and complete such examinations or facts may result in my rejection or dismissal If hired, I agree to abide by all the rules and policies of the employer. This certified that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. Date Applicant s Signature Date of birth: The US Department of Transportation requires that driver applicants must state their date of birth (~391.21 (b)(2)) Social Security Number: Drivers License No.
Animal Experience PLEASE BE AS DETAILED AS POSSIBLE Company: Contact name: Location: Phone #: Title: Dates: to Animals worked with (please list all) Job Duties (please be descriptive): Reason For Leaving: Company: Contact name: Location: Phone #: Title: Dates: to Animals worked with (please list all) Job Duties (please be descriptive):