Employment Application

Position Desired:
Date:
On what date would you be available to start work?
Are you willing and available to work:










Please list any schedule preferences you have:
   
Personal
Name (last, first, middle):
Social Security #:
Phone #:
Work #:
Address:
City:
State:
Zip Code:
Previous Address (for at least the last five years)
Address:
City:
State:
Zip Code:
Are you at least 18 years old?    
If no, are you younger than 16?    
If yes, do you have a work certificate?    
Are there any required deductions from the state, federal or private credit agency that you may have?
(ex. Student loans)
   
Name of Agency:
Have you been convicted of a crime
in the last five years?
(Do not include misdemeanors or traffic violations)
   
If yes, please explain:
   
Educational Background
High School Name:
Address:
Course or Major:
Graduated?
College Name:
Address:
Course or Major:
Graduated?
Other School Name:
Address:
Course or Major:
Graduated?
   
Employment
Have you ever applied for work at this company?    
If yes, where and when?
How were you referred to us?
We need to know about your last five years of employment. If you need more room, let us know. If you have never been employed, please write the names of non-relatives who can be contacted for reference. You may include any verified volunteer work.
Are you currently employed?                   
   
Current or Last Employer
Company:
Address:
Phone #:
Supervisor Name & Title:
Position:
Dates Worked (from-to):
Duties:
Pay Rate:
Reason for Leaving:
   
Previous Employer
Company:
Address:
Phone #:
Supervisor Name & Title:
Position:
Dates Worked (from-to):
Duties:
Pay Rate:
Reason for Leaving:
   
Previous Employer
Company:
Address:
Phone #:
Supervisor Name & Title:
Position:
Dates Worked (from-to):
Duties:
Pay Rate:
Reason for Leaving:
   
Previous Employer
Company:
Address:
Phone #:
Supervisor Name & Title:
Position:
Dates Worked (from-to):
Duties:
Pay Rate:
Reason for Leaving:
   
May we contact all the employers listed above?    
If not, which ones should we not contact and why?
Have you ever been disciplined, suspended, discharged, or asked to resign from a job in connection with a loss of money, merchandise, or equipment?    
If yes, please explain:
Have you ever been disciplined or discharged
for absenteeism or tardiness?
   
If yes, please explain:
   
Have you ever worked for Pet Quarters
previously in any of our locations? Where?
Why are you interested in a job with us?
What starting wage do you expect to receive?
What interests do you have outside of work that compliment your job skills?
If hired, how long do you think you
will work for Pet Quarters?





What is the LEAST number of hours
per week you can work?
What is the MOST number of hours
per week you can work?
   
It is important we clearly understand what days and times during each day (or night) that you are available to work. For each day below, write in the range of hours (earliest and latest), with AM and PM noted, you are available.
(PLEASE NOTE: Schedule preferences will be discussed in your interview. Weekends are our businest days. Ability to work a flexible schedule may increase the number of hours we are able to provide you.)
DAY OF THE WEEK HOURS AVAILBLE
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY

Please read the following information carefully.

An Equal Opportunity Employer
In compliance with Federal and State equal employment opportunity laws, all qualified candidates will be considered for employment without regard to their race, creed, color, national origin, ancestry, sex, age, marital status, veteran status, or the presence of non-job related medical conditions or disabilities.

Applicant’s Certification and Agreement

  • The distribution or receiving of this application by the Company does not imply or intend to imply an agreement or contract to employ the applicant. The purpose of this application is solely to allow persons a standardized form on which to submit their qualifications. This application will be considered valid for no longer than three months. Re-application is necessary after three months.
  • I authorize all persons, schools, employers, and organizations mentioned in this application to provide the Company with any and all information requested by the Company, and I voluntarily release such persons, schools, employers, and organizations from all liability for providing such information.
  • In the event I am employed by the company, I agree to comply with all its rules, regulations, and directives. I understand that my employment is for no stated term and is subject to termination at the will of the company.
  • I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would affect this application unfavorably. I understand that falsification, misrepresentation, or omission of facts called for in this application may result in denial of employment or immediate dismissal. I hereby acknowledge that I have read, understand, and consent to the above statements.
  • I also understand that if offered employment, I must prove my identity and my eligibility to work in the United States, prior to being employed.

Enter the code you see:
(it is not case sensitive)
  

animalgroupcartoon-characters-126Pet Quarters
3 Ledgeview Drive
Westbrook, ME 04092
207-761-4551 ext 329 for Customer Service

petquarters@petquartersne.com