DeKalb County Animal Services/LifeLine Animal Project

Employment Application Form

PLEASE ENTER ALL INFORMATION REQUESTED
This is an application for employment. This application does not constitute any employment
relationship between DeKalb County Animal Services or LifeLine Animal Project and the applicant herein.
Date (*)
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Last Name
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First Name
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Middle Name
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Maiden
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Present Address
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City
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State
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Zipcode
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How Long at Address
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Email Address
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Social Security No
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Telephone
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If under 18, Please list age
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Position applied for             (1)
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and salary desired                (2)
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Day/Hours Available to work
No Pref
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Mon
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Tue
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Wed
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Thur
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Fri
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Sat
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Sun
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How many hours can you work weekly?
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Can you work nights/weekends?
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Employment Desired?
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When available for work?
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High School - Name of School
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High School Location
(Complete mailing address)
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High School - Number of Years COMPLETED
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High School Graduated?
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College - Name of School
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College Location
(Complete mailing address)
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College - Number of Years COMPLETED
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College Major & Degree
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Bus or Trade School - Name of School
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Bus or Trade School Location
(Complete mailing address)
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Bus or Trade School - Number of Years COMPLETED
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Bus or Trade School Major & Degree
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Professional School - Name of School
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Professional School Location
(Complete mailing address)
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Professional School - Number of Years COMPLETED
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Professional School Major & Degree
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HAVE YOU EVER BEEN CONVICTED OF A CRIME?
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If yes, explain number of convictions(s), nature of offense(s) leading to conviction(s),
how recently such offense(s) was/were committed, sentences(s) imposed, and types(s) of rehabilitation
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Do you have a Driver's license?
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What is your means of transportation to work?
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Driver's License Number
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Expiration Date
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State of Issue
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Type of License
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Have you had any accidents during the past three years?
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How Many Accidents?
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Have you had any moving violations during the past three Years?
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How Many moving Violations?
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Office Jobs Only
Typing
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WPM?
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Personal Computer Knowledge
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PC / MAC Knowledge
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10-Key
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Word Processing Knowledge?
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WPM
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Other
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Skills
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Please List Two References other than relatives or previous employers.
Reference One
Reference Name
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Position
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Company
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Address
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Phone Number
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Reference Two
Reference Name
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Position
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Company
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Address
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Phone Number
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An application form sometimes makes
it difficult for an individual to adequately summarize
a complete background. Use this space to copy/paste a cover letter or
to summarize any additional information
necessary to describe your full qualifications for
the specific position for which you are applying.
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Military Service
HAVE YOU EVER BEEN IN THE ARMED FORCES?
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ARE YOU NOW A MEMBER OF THE NATINAL GUARD?
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Specialty
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Date entered
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Discharge Date
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Work Experience

Please list your work experience for the past three employers beginning with your most recent job held. If you were self-employed, give firm name.

Please Upload your Resume Here
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Name of Employer
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Employer Complete Address, City, State, Zip and Phone Number
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Name of Last Supervisor
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Your Last Job Title
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Employment Date: From
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Employment Date: To
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Check If you are Currently Employed at this job
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Pay or Salary (annual): Start
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Pay or Salary (annual): Final
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Reason for Leaving (be specific)
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List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
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Check to add Second Employer --- >
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How many Cats do you currently have? # Cats
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How many Dogs do you currently have? # Dogs
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How many other pets do you currently have? # Other
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If you do not own pets, why?
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  Please describe your first pet
Breed/Type
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Age
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Spay/Neutered?
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How Long have you had Pet?
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Are your current pets up-to date on shots?
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Are your dogs on heartworm prevention?
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What is the Name and Phone number of your veterinarian?
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How many pets have you had in the past 5 years? Where are those pets now?
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May we contact your present employer?
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Did you complete this application yourself?
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If not, who did?
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PLEASE READ CAREFULLY

AUTHORIZATION FOR RELEASE OF INFORMATION

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give DeKalb County Animal Services (DCAS) and LifeLine Animal Project permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release DCAS and LifeLine Animal Project from any liability as a result of such contact. I also understand that (1) DCAS/LifeLine has a drug and alcohol policy that provides for potential pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations as may apply.

You must check box and Agree to above statement before Submitting Application

By typing your name here and clicking "Submit" below - this will constitute a valid signature (*)
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Date (*)
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DeKalb County Animal Services/LifeLine Animal Project is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability.

Thank you for completing this application form and for your interest in working with DCAS/LifeLine.