Job Application | Employment Application

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Personal Information

Your Name*

First Last

Have you ever used another name?*

Yes

If yes, please state name(s), dates, and circumstances:

Present Address*

Street Address Address Line 2 City State ZIP Code

Your Phone*

Alternate phone

Email Address*

Date you are available to begin work*

MM slash DD slash YYYY

Are you willing to work flexible hours, which could include weekends and/or holidays?*

Yes

Is your availability for work limited?*

Yes

If yes, please indicate which hours and days of the week you are unavailable

Do you plan to engage in other work while in our employ?*

Yes

If yes, please describe the work, as well as the hours and days of the week involved

Criminal convictions do not bar consideration for employment. Factors such as age at time of conviction, length of time since offense, seriousness of offense, and rehabilitation will be considered.

Have you ever entered a plea of guilty or nolo contendere to been found guilty of, or been convicted of a felony, irrespective of an order granting probation or suspending the imposition of sentence?*

Yes

If yes, please list below all misdemeanors and felonies (other than parking tickets and minor driving violations).

Year

Location (City and State)

Type of crime

Are you currently on probation or parole for any conviction?*

Yes

If yes, please specify

In case of emergency, notify:

Name

Relationship

Address

Work Phone

Home Phone

Education

High school

Name and location of school

Years Attended

Did you graduate?

Degree(s) Received or Subject(s) Studied

College

Name and location of school

Years Attended

Did you graduate?

Degree(s) Received or Subject(s) Studied

Trade school

Name and location of school

Years Attended

Did you graduate?

Degree(s) Received or Subject(s) Studied

US Military Service

Have you been in the United States military service?

Yes

If yes, branch of service

Date of Service

MM slash DD slash YYYY

Nature of duty or training

Ending rank

Are you currently a member of the military reserves?

Yes

Employment History

We routinely contact an applicant’s current and previous employers for reference checks. Are you currently employed?

Yes

Please provide your complete work history for the preceding three employers or past three years, whichever is greater.

Current or last employer name

Phone

Address

From

Position and duties

Reason for leaving

Next previous employer name

Phone

Address

From

Position and duties

Reason for leaving

Next previous employer name

Phone

Address

From

Position and duties

Reason for leaving

Please explain all periods of unemployment between the above jobs

Have you ever been terminated from employment or asked to resign by any employer?

Yes

If yes, please explain

Transportation

Do you have reliable transportation?

Yes

If yes, Year

Make

Model

Current mileage

Consent*

I hereby authorize Poopie Patrol to investigate all statements contained in this application. I further authorize my previous employers to release any and all information regarding my past work history to Poopie Patrol for use in consideration of my application for work. I agree to waive all statutory and common law rights, and any private causes of action whatsoever, concerning the release, receipt and/or consideration of such information. I certify that all the information provided on this application is true and complete to the best of my knowledge. I understand that any false or misleading information, or the significant omission of relevant facts may disqualify me from further consideration as an employee and may be considered justification for termination if discovered at a later date. I understand that this is an application only and that it does not constitute an offer of employment.*

Signature*

Date*

MM slash DD slash YYYY

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