"*" indicates required fields Today's Date* MM slash DD slash YYYY Name First Middle Initial Last Are you looking for FULL-TIME?* YES NO Are you looking for PART-TIME?* YES NO Are you available to work every other Saturday 8am-12pm?* YES NO What other days are you available to work? (circle all that apply):* Monday Tuesday Wednesday Thursday Friday Desired Start Date* MM slash DD slash YYYY Desired Job Position* Desired starting salary* $/HRDo you need insurance benefits?* YES NO Contact Phone Number(s) Add RemoveAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM slash DD slash YYYY SSN* Do you have any physical conditions/handicaps that would prevent you from performing duties such as lifting a large dog or carrying a 40-50 lb bag of dog/cat food?* YES NO Do you have experience in any of the following? (check all that apply):* Accounting Vet Assistant Reception Sales Customer Service Cashier (ability to handle money transactions accurately and responsibly) Please select highest education level completed:* Highschool: 9 Highschool: 10 Highschool: 11 Highschool: 12 Trade-School: 1 Trade-School: 2 College: 1 College: 2 College: 3 College: 4 Other List the last 3 jobs held*Job Title / DutiesDatesBrief Description Add RemovePlease list the name, city & phone number of 3 people (non-relatives) you have worked for/with and whom we may contact for references:*NameCityPhone Number Add RemoveIf you are currently employed, may we contact your employer for a reference? If yes, please list place of employment, supervisor’s name, city & contact phone number. If no, please leave blank:CommentsThis field is for validation purposes and should be left unchanged.