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Home
Adoptable Animals
Events
Birthday Party Info
Donate
Become A Sponsor
Cat Stream!
Store
The Babinski Foundation Animal Shelter
Adoption Forms
Foster Forms
Volunteer Info
Sponsors
Employment
Helpful Links
Lost & Stray Animals
FAQ
Contact
Employment Application
Applicant Information
The following information is requested to help us make the best possible placement within the foundation. All required portions of this application pertaining to you must be completed. We appreciate the time you spend in filling out this application form. The company, in accordance with local, State and Federal laws, does not discriminate based on age, race, religion, color, sex, national origin, marital status, sexual orientation, disability, status about public assistance, or any other protected classification.
Name:
*
First Name
Last Name
Phone:
*
(###)
###
####
Email Address:
*
Current Address:
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Duration at current address:
*
Previous Address:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Duration at previous address:
What positions are you applying for?
*
Check all that apply
Adoptions
Administrative
Animal Care
Cleaning
Intake
Marketing
Medical
Volunteer Leadership
What species do you prefer to work with?
*
Cats
Dogs
No preference
Work Days Available:
*
Check all that apply
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Work Schedule Availability:
*
Check all that apply
Morning (7AM - 11AM)
Noon (11AM - 3PM)
Afternoon (3PM - 7PM)
Are you looking for a full time or part time position?
*
Check all that apply
Full Time
Part Time
Desired pay rate or salary:
*
Have you ever worked at The Babinski Foundation before?
*
Yes
No
Are you a citizen of the United States?
*
Yes
No
Are you legally entitled to work in the United States?
*
Yes
No
Have you been charged with a felony?
*
Yes
No
If yes, when and what was the charge.
Emergency Contact Information
This section is for you to put down all of your medical emergency contact information, if you wish to do so. This information will not be used for any other purpose.
Insurance Company:
Policy Number:
Doctor's Name:
First Name
Last Name
Doctor's Phone Number:
(###)
###
####
Emergency Contact:
First Name
Last Name
Emergency Contact's Number:
(###)
###
####
Education History
High School Name:
High School Address:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Years attended high school:
Did you graduate from this high school?
Yes
No
College Name:
College Address:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Years attended college:
Did you graduate from this college?
Yes
No
Degree Name:
Other Education:
Please list the name of the facility
Other Education's Address:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Years attending this facility:
Did you graduate?
Yes
No
Degree name:
Employment History
Feel free to put down volunteer work as well. I certify that the information contained in this application is correct to the best of my knowledge, and understand that falsification of this application in any detail is grounds for disqualification from further consideration or for dismissal from employment in accordance with company policy. I agree to conform to the company guidelines and rules of the company, and understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or myself. I further understand that no personnel recruiter or interviewer, other than the owner or the company or authorized agent has any authority to enter into any agreement for employment for any specified period of time.
1. Employer Name:
1. Occupation:
1. Final Pay Rate or Salary:
1. May we contact?
Yes
No
1. Employer Phone Number:
(###)
###
####
1. Employer Address:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
1. Date Started:
MM
DD
YYYY
1. Date Ended:
MM
DD
YYYY
1. Briefly describe job duties:
1. Reason for leaving:
2. Employer Name:
2. Occupation:
2. Final Pay Rate or Salary:
2. May we contact?
Yes
No
2. Employer Phone Number:
(###)
###
####
2. Employer Address:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
2. Date Started:
MM
DD
YYYY
2. Date Ended:
MM
DD
YYYY
2. Briefly describe job duties:
2. Reason for leaving:
3. Employer Name:
3. Occupation:
3. Final Pay Rate or Salary:
3. May we contact?
Yes
No
3. Employer Phone Number:
(###)
###
####
3. Employer Address:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
3. Date Started:
MM
DD
YYYY
3. Date Ended:
MM
DD
YYYY
3. Briefly describe job duties:
3. Reason for leaving:
References
Please list two non-related references .
First Reference:
*
First Name
Last Name
First Reference's Phone Number:
*
(###)
###
####
Second Reference:
*
First Name
Last Name
Second Reference's Phone Number:
*
(###)
###
####
Additional Information
Please list any pet's you currently have in your household:
Include their name, species, and age.
Do you have any physical or medical limitations which may limit your participation as a employee?
Have you ever consulted with a professional person for psychological disorders concerning animals?
Do you have your own transportation?
Yes
No
Do you have an insured truck or van?
Yes
No
Why do you want to work at the Babinski Foundation?
List any additional information or concerns:
Disclaimer
I certify that my answers are true and complete to the best of my knowledge. I certify that my answers are true and complete to the best of my knowledge. If this application leads to me becoming an employee, I understand that false or misleading information in my application may result in my release from the Babinski Foundation. I understand that the Babinski Foundation will be conducting a formal background check. I agree to hold all information shared with me while working at the Babinski Foundation in strict confidence. I authorize any person, agency or institution to release information concerning me. This information will be used to determine my eligibility for employment.
Confidentiality Agreement
This confidentiality agreement is required for the protection of the Babinski Foundation and in recognition that employees/volunteers/board members of the Babinski foundation may either acquire or observe documents, or overhear conversations, or information that is private and confidential in nature. Accordingly, the undersigned employee/volunteer/board member agrees that if he or she comes into possession of either written or oral information of any kind about the Babinski Foundation about its employees/volunteers/board members, or clients as the result of employment/volunteer/board work with the Babinski Foundation, the undersigned agrees to keep all such information confidential and not disclose or publish this information to any person unless expressly permitted in writing by the Babinski Foundation executive director. It is acknowledged that this agreement is not only for the protection of the Babinski Foundation and its clients regarding their confidential information but the agreement is also a reminder to the undersigned that inappropriate disclosure of such information by the undersigned could expose the undersigned to liability or claims if the disclosure of such information cause either monetary damage or other irreparable harm to the Babinski Foundation or its clients.
Signature
*
By entering my full name here, I fully agree to the above written disclaimer and Confidentiality Agreement.
Thank you!
