Angie's Groom 'n Board Employment Application


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NameAngie's Groom 'n Board Employment Application
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Angie's Groom 'n Board Employment Application
Please print Date ______________________
Name ____________________________________________________________________________________

(last) (first) (middle)
Address __________________________________________________________________________________

(number & street) (city) (zip)
Telephone (Home) ______________________ E-mail (optional) _____________________________

1. Do you have the legal right to work in the United States? Yes ____ No ____

If hired by this firm, you must complete an I-9 form (Employment Eligibility Verification)

2. You must be at least 18 years of age to work here Yes ____ No ____

3. Since your 18th birthday, have you been convicted of a felony and/or related misdemeanor? Please answer Yes or No. If Yes, please list circumstances, place and dates____________________________________________ _______________ __________________________________________________________________________________________________
4. What days of the week are you available to work? (Circle) m t w th f s s

Are you willing to work holidays? ______

5. In case of emergency, contact: ______________________________________________________________________

(name) (phone)

6. Education and Training

Name & Address (city & state)

High School _______________________________________Years______ Did you graduate?____ What Year?___ _______

College __________________________________________________ Major _______ Years _____Degree_______

Trade Schools __________________________________ Subject _____________ Date Graduated ________

Are you computer literate Yes _____ No_____ PC _____ MAC _____

Have you operated a cash register _________ Credit Card Terminal __________

7. Do you hold any special Licenses or Certificates?

List type and date acquired _____________________________________________________________

From what organization or State _________________________________________________________
References: List 3 persons not work related that you have known for 1 year or more

Name____________________________________ Address _______________________Phone ______________

Name____________________________________ Address _______________________Phone ______________

Name____________________________________ Address _______________________Phone _____________

Check what you are applying for: Groomer ____ Brusher/Bather only _____ Assistant Groomer ____ Receptionist ______ Kennel Assistant_______

Desired Wage________

If you show dogs in conformation, list breed or breeds _______________________________________ Do you show in Obedience? Yes ____ No ______ Agility? Yes ____ No ______


Employment History: List your present or most recent employer first. If currently employed, may we contact your employer? Yes ____ No _____

1.Employer. _____________________________ Address ________________________ City/State_____________

Name of Supervisor _______________________________________ Telephone _____________________

Job Title __________________ Dates of Employment. From ______________ To ___________________

Job Duties (brief statement; be sure to list all duties related to his position) _______________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Reason for leaving: ____________________________________________________________________________

May we contact your previous supervisor for a reference? YES NO

2. Employer. ____________________________ Address ________________________ City/State_____________

Name of Supervisor _______________________________________ Telephone _____________________

Job Title __________________ Dates of Employment. From ______________ To ___________________

Job Duties (brief statement; be sure to list all duties related to his position) _______________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Reason for leaving: ____________________________________________________________________________

May we contact your previous supervisor for a reference? YES NO
3. Employer. ____________________________ Address ________________________ City/State _____________

Name of Supervisor _______________________________________ Telephone _____________________

Job Title __________________ Dates of Employment. From ______________ To ___________________

Job Duties (brief statement; be sure to list all duties related to his position) _______________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Reason for leaving: ____________________________________________________________________________

May we contact your previous supervisor for a reference? YES NO

Please answer the following questions:

1.) How did you hear about us?
2.) Do you have special training or education that would apply to working with animals?
3.) Do you own any pets? Give a description.
4.) What type of discipline do you consider appropriate for a dog?
5.) Have you ever cared for a dog that was not your own?
6.) Have you ever had a dog that required medical attention or needed treatment for an injury? Please explain.
7.) Have you ever been in a situation with an aggressive dog? A fearful dog? What happened?
8.) Do you have any physical limitations that might affect your ability to handle dogs at Angie’s Groom ‘n Board?
What Questions do you have for us?

I understand that this is an application for employment and not an agreement or contract for employment. As part of the application process, I understand that I may be required, if applicable, to demonstrate my grooming and/or brushing/bathing skills. I certify that all of the statements provided in this application are true, complete and correct to the best of my knowledge and belief. I understand that the information I have provided may be verified and that falsification of information may be grounds for disqualification. I also hereby give my consent to a background & drug test.
Signature _____________________________________________________ Date _____________________

PRE-EMPLOYMENT DRUG/ALCOHOL TESTING CONSENT AND RELEASE FORM




I hereby consent to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis, as shall be determined by Angie’s Groom ‘n Board

__________________________________________ in order to meet with their policy regarding the selection of applicants for employment.
I further authorize and give full permission to have Angie’s Groom ‘n Board and/or its authorized agents and physicians to send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the Company. I further agree to and hereby authorize the release of the results of said tests to the Company.
I understand that it is the current use of illegal drugs that would prohibit me from being employed at this Company.
I further agree to hold harmless the Company and its agents and physicians from any liability arising in whole or part, out of the collection of specimens, testing, and use of the information from said testing in connection with the Company's consideration of my application of employment.
I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.
I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.
APPLICANT: Print Name: ____________________________ S.S.#: __________________
Signature: ____________________________ Date: ___________________
WITNESS: Print Name: _________________________ Signature: ____________________________

AUTHORIZATION AND RELEASE TO OBTAIN INFORMATION:
Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act and all applicable federal, state, and local laws, I hereby authorize and permit Angie’s Groom ‘n Board to obtain a consumer report and/or an investigative consumer report which may include the following:

  1. My employment records;

  2. Records concerning any driving, criminal history, credit history, civil record, workers’ compensation (post-offer only) and drug testing.

  3. Verification of my academic and/or professional credentials: and information and/or copies of documents from any military service records.


I understand that an “investigative consumer report” may include information as to my character, general reputation, personal characteristics, and mode of living, which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information.

I agree that a copy of this authorization has the same effect as an original.

I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, as well as from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information.

I understand and acknowledge that under provision of the Fair Credit Reporting act I may request a copy of any consumer report from the consumer reporting agency that compiled the report, after I have provided proper identification.

I hereby authorize Angie’s Groom ‘n Board to obtain and prepare an investigative consumer report as set forth above, as part of its investigation of my employment application. This authorization shall remain in effect over the course of my employment. Reports may be ordered periodically during the course of my employment.

Full Name: (Please print clearly)_________________________________Signature:________________________ Date:_____
Address:________________________________________________ Date of Birth:_______________

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