Wag n Wash Healthy Pet Center - Colorado Springs, Colorado

Application for Employment
Items marked with * are required.

PRE-EMPLOYMENT QUESTIONNAIRE - EQUAL OPPORTUNITY EMPLOYER

Personal Information
Last Name*
First Name*
Social Security Number
--
Email*
Present Address*
City*
State*
Zip*
Permanent Address
City
State
Zip
Phone*
Referred by
Wag N' Wash Location*


Employment Desired
Position*
Date You Can Start*
Salary Desired*
Are you employed?*
Yes No
Can we speak to your employer?*
Yes No
Have you applied before?*
Yes No
Where?
When?


Educational History
  Name/Location* Years Attended* Graduated* Subjects Studied*
Grammar School Yes No
High School* Yes No
College Yes No
Trade, Business or Correspondence School Yes No


General Information
Subjects of Special Study/Research Work or Special Training/Skills*
US Military or Naval Service?
Yes No
Rank


Former Employers
(List below last four employers, starting with last one first)
From/To Name/Address/Phone Salary Position Reason for Leaving
/* * * * *
/
/
/


References
(Give below the names of three persons not related to you, whom you have known at least one year.)
Name* Address* Business* Years Known* Contact Information*


GENERAL INFORMATION
What personal and/or professional experience do you have with cats and dogs?*
What personal and/or professional experience do you have with natural pet foods?*
What other special training or skills do you have that would apply to this position?*
What else would you like us to know about you?*

AUTHORIZATION & ELECTRONIC SIGNATURE
"Please read the following completely. When through, choose the "I agree and sign" button to state that you have read and agree with this authorization. YOUR CHOOSING THE "I AGREE AND SIGN" BUTTON WILL BE CONSIDERED YOUR ELECTRONIC SIGNATURE AND AUTHORIZATION. "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the reference and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release Wag N' Wash® Healthy Pet Centers, Healthy Pet Partners, LLC. and it's affiliates from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.""

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