Application for EmploymentPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastHome Address *Address Line 1Address Line 2CityWashingtonAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMailing Address If Different from Home AddressAddress Line 1Address Line 2CityWashingtonAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Primary PhonePosition Sought: *Have you reviewed and do you fully understand the responsibilities and requirements outlined in the job description?YesNoAre you currently employed? *YesNoAvailable Start Date: *Do you have any friends, relatives or acquaintances working for SPCHS? *YesNoIf yes, state name & relationship:Do you have transportation to/from work? *YesNoYou will be required to work a variety of shifts. Morning shifts begin at 7am and typical last 4-5 hours. Evening shifts start at 4:30pm and typically last 2 hours. Weekend and holiday availability is also required.Are you over the age of 18? *YesNoIf hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? *YesNoIf hired, are you willing to submit to and pass a controlled substance test? *YesNoAre you willing to submit to a background check?YesNoWithin the last ten years, have you been charged with or convicted of any crime involving animal neglect or cruelty?YesNoAre you able to perform the essential functions of the position you are applying for, with or without reasonable accommodation? *YesNoIf no, please describe the functions you are unable to perform: (Note: SPCHS complies with the Americans with Disabilities Act (ADA) and will consider reasonable accommodation for qualified applicants.)Name and Location of high school education:Did you graduate? *YesNoName and Location of college or university education:Did you graduate?YesNoDegree, major/subjects of studies:Name and Location of any specialized training, trade school, etc.:Did you graduate?YesNoAreas of study:Name and Location of any other training:Did you graduate?YesNoMajor/Subjects of study:Please list your strongest areas of proficiency, any special skills, or other qualifications that may support your success in this position.Please provide the name and address of the company of your most recent employment:Dates employed:Your role/title:May we contact them?YesNoIf yes, please provide their contact telephone number:Please provide the tasks your performed and reason for leaving:Please provide company name and location, dates employed, role/title, tasks performed and reason for leaving for any other previous employment:May we contact them?YesNoIf yes, please provide their contact number:In case of emergency, please notify: *FirstLastRelationship *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePrimary Phone *Alt PhoneI certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application. I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees. In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required. I understand that employment at this company is "at will", which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements. *FirstLastDate / Time *DateTimePhoneSubmit
