Potsdam Humane Society Employment Application

Potsdam Humane Society is an Equal Opportunity Employer.

Federal and State Law prohibits discrimination because of race, color, creed, religion, sex, sexual preference, national origin, age, marital status, disability, or veteran’s status and requires affirmative action in the employment of women, minorities, handicapped individuals, disabled veterans and veterans of the Vietnam Era.

To help us learn about your experience, abilities, and interest, please complete this Application for Employment thoroughly, even if you have also provided us with a resume. We will review your qualifications and will make every effort to reach a decision as quickly as possible.

BE SURE YOU READ ALL INSTRUCTIONS CAREFULLY, COMPLETE THE ENTIRE APPLICATION, AND SIGN. FAILURE TO COMPLETE THIS APPLICATION IN ITS ENTIRETY MAY DISQUALIFY YOU FOR CONSIDERATION.

Personal Information

Last Name *

First Name *

Middle Initial

Present Mailing Address *

City *

State *

Zip

Present Telephone Number *

Email

Do you have any pets presently? *

Yes

No

Have you ever adopted an animal from the Potsdam Humane Society? *

Yes

No

If so, when?

Do you have experience caring for animals? *

Yes

No

If yes, please describe:

Describe why you want to work for the Potsdam Humane Society? *

Employability

Do you have a legal right to accept employment in the United States? *

Yes

No

Proof of citizenship or immigration status will be required upon employment.

Licenses

Do you have a current valid motor vehicle operator’s license? *

Yes

No

License Class

A

B

C

Issuing State

Endorsements?

License Number

Valid from:

Valid to:

If you have applied for a license, but it has not yet been issued, give date of application:

Military Service

Did you ever receive a discharge from the Armed Forces of The United States which was other than “Honorable” or which was issued under other than Honorable circumstances? *

Yes

No

If yes, give details:

Proof of military service will be required upon employment.

Criminal Convictions

Have you ever plead guilty to or have been convicted of a crime? *

Yes

No

If Yes, give details. Show for each offense: (1) date, (2) charge of which you were convicted, (3) place, (4) court, (5) action taken.

A conviction does not automatically mean you cannot be appointed. What you are convicted of, and how long ago, are important. Give all the facts so that a decision can be made.

Medical

Do you agree to take a medical examination if required? *

Yes

No

Do you agree to substance abuse screening if required? *

Yes

No

If you answer No, give details:

Your Job Interests

Position Applied For: *

In many jobs, one or more of the following conditions are required, and inability to satisfy these work schedules may limit further consideration of your application. Please indicate whether you are able to perform:

Shift work? *

Yes

No

Overtime work? *

Yes

No

A work schedule that includes Saturday & Sunday? *

Yes

No

On what date would you be available to begin work? *

Education Type

High School

Equivalency Program

Vocational or Tech. Schools

Colleges or Universities

Advanced Studies

Other Training or Military Schools

Other Special Skills or Training (if Applicable)

Employment Experience

Upload Resume (Optional)

No Choosen File

(Max 3 MB)

If not uploading a resume, please list your history starting with your most recent position. Include any periods in which you weren’t employed.

Include U.S. Military experience (show rank/rate at discharge), summer/part-time jobs, and cooperative assignments.

Current Employer(s)

Employer Name

City

Starting Position Title

Starting Date

May we contact your present employer now?

Yes

No

If not now, when?

Please describe your responsibilities and/or accomplishments:

Previous Employers

Employer Name

City

Starting Position Title

Starting Date

Explain reason for leaving:

Please describe your responsibilities and/or accomplishments:

PERSONAL PRIVACY PROTECTION LAW

The information you submit on this application will be used to determine your qualifications for employment, and will be used in accordance with Section 96 (1) of the Personal Privacy Protection Law. Failure to provide the requested information may affect your employment status.

PRE-EMPLOYMENT SCREENING AUTHORIZATION

I hereby authorize the Potsdam Humane Society to conduct a pre-employment screening and authorize any former or present employer, credit bureau, military records center and school to provide the Potsdam Humane Society any and all information, including, but not limited to, information as to your character, habits, work, ability, and/ or claims, liabilities or damage.

Signature *

Date *

AFFIRMATION

I affirm that all statements made by me on this form, including attached papers, are true and correct to the best of my knowledge. I understand that falsification or omission of information is cause for dismissal from employment.

I further understand that the Potsdam Humane Society is an At-Will Employer. At-Will Employment means I can leave the Potsdam Humane Society at any time, and the Potsdam Humane Society can terminate my employment at any time.

Signature *

Date *

GIVE NOW

GIVE NOW

Potsdam Humane Society Employment Application

Personal Information

Employability

Licenses

Military Service

Criminal Convictions

Medical

Your Job Interests

Education Type

Employment Experience

PERSONAL PRIVACY PROTECTION LAW

PRE-EMPLOYMENT SCREENING AUTHORIZATION

AFFIRMATION

Potsdam Humane Society Employment Application

Personal Information

Employability

Licenses

Military Service

Criminal Convictions

Medical

Your Job Interests

Education Type

Employment Experience

PERSONAL PRIVACY PROTECTION LAW

PRE-EMPLOYMENT SCREENING AUTHORIZATION

AFFIRMATION

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