Employment Applications v1.2

Last Name First Name Middle Name
Address Apt. City, State Zip
,
Daytime Phone (with area code) Alternate Phone E-mail address
Position(s) Applying For Are you seeking:
Full Time Part Time Temporary Work
Minimum Salary Desired? Please indicate the hours you are available to work.
(Evenings & weekends are generally required)
If we offer you a position when will you be able to work? Have we previously employed you? Have you ever applied to us before?
Yes No
If yes, when? 		Yes No
If yes, when?
How did you learn of this opening? If someone referred you, name them. If related to anyone in our employ,
state that person’s name:
Have you ever used another name? If you are under 18, a work permit may be required prior to working.
If so, please state: At least 18 At least 16
If hired, can you present proof of you legal right to live and work inthis country? Are you willing and able to perform the essential functions of the job for which you are applying? See page #6, Physical Requirements details.
Yes No Yes No
Are you willing and able to work overtime, as may be required by the job for which you are applying? Are you willing and able to report to work on time and to attend work on a regular and consistent basis as scheduled?
Yes No If no, please explain:
Yes No If no, please explain:
Have you ever been convicted of a felony, or felony within the last seven years, a misdemeanor that resulted in imprisonment? Have you been convicted of a misdemeanor that resulted in imprisonment in the last seven years?
Yes No If yes, please describe:
Such a conviction will not necessarily disqualify an applicant from employment 		Yes No If yes, please describe:

Such a conviction will not necessarily disqualify an applicant from employment
Are you presently out on bail or on your own recognizance pending trial?
Yes No
* Applicant may omit any convictions for the possession of marijuana (except for convictions for the possession of marijuana on school grounds or possession of concentrated cannabis) that are more than two (2) years old, and any information concerning referral to, and participation in, any pretrial or post trial diversion program.
Store Location Preferences
Business Experience
Start with your present or most recent position and include all employment history for the past five years. Use additional sheets if necessary.

Please fill out completely even if submitting a resume with your application.
Are you currently employed? Yes No If employed, may we contact your present employer? Yes No

Previous Employer(most recent or current):

Previous Employer #2:

Previous Employer #3:

Previous Employer #4:
Education
Check highest year completed High school Check highest year completed College/Grad school
1 2 3 4 1 2 3 4 5 6 7 8
School
Computer Skills
Pet Knowledge (only applicants for retail store positions need to complete this section)
Work History
Have you ever been terminated or asked to resign from a job? Yes No  If yes, please explain:
Please list any activities, memberships, awards, licenses, or accomplishments that you feel may be relevant and that you would like us to consider in evaluating your application
Why are you interested in working for Pet Food Express? List skills, abilities, and strong points that you feel particularly qualify you for a position with us and will help you succeed in this job.
What are your weaker points and areas that need improvement?.
AT WILL EMPLOYMENT AND ACCEPTANCE STATEMENT

I certify that the information contained in this application is true and correct. Further, I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. If I am offered employment, I agree that prior to or at the commencement of my employment I will provide original documents to Pet Food Express which verify my identity and right to work under the Immigration Reform and Control Act of 1986 (“IRCA”). I also agree that Pet Food Express may provide photocopies of the form on which my identity and right to work is verified (the “I-9” Form) and any supporting documentation submitted by me to any person who, in connection with effecting compliance with IRCA, has legitimate interest in the information contained therein.

Additionally, I understand that nothing contained in this application or conveyed during any discussion or interview which may be granted to me is intended to create a contract between me and Pet Food Express for either employment or the provision of any benefits. No express or implied promises or representations regarding employment or the duration of employment have been made to me, and I understand that no such promises or representations are binding on Pet Food Express unless made in writing and signed by me and the President of the Company. I further understand that if an employment relationship is established, I will have the right to terminate my employment at will at any time and Pet Food Express will retain a similar right to terminate my employment at will (that is, with or without advance notice and with or without cause). I understand that no agreement contrary to at-will employment can be made with me unless in writing and signed by the President of the Company.


BY CHECKING THE BOX MY NAME BELOW, I CERTIFY THAT I HAVE READ, UNDERSTOOD, AND ACCEPTED THE POLICIES AND PROVISIONS LISTED IN THIS APPLICATION. YOU MAY BE ASKED TO SIGN THIS DOCUMENT IF GRANTED AN INTERVIEW.
Name: Date:
Signed:  
Name: Date:

FROM: Georgiana Chu, Human Resources

Re: AUTHORIZATION FOR BACKGROUND CHECK

I hereby authorize Pet Food Express and its officers, employees and agents to thoroughly investigate my references, work record, education and any other matters related to my suitability for employment and, further, authorize my present and former employers and schools to disclose to this employer any and all of my employment and school records, including disciplinary reports and letters of reprimand, without giving me notice of such disclosure. In addition, I hereby release and indemnify Pet Food Express and its officers, employees and agents, and my present and former employers and schools, and their officers, employees and agents, and all other persons, from all liability for any damage that may result from such investigation or disclosure, including, but not limited to, Pet Food Express’ refusal to hire me.


Signature: __________________________________________________________ Date: _____________

Complete this section below prior to interview – do not complete electronically

Physical Job Requirements For Store Personnel
Working in a Pet Food Express store requires that you be able to carry out certain job functions on a regular basis. These include but are not limited to the list below. Review the list below and check only those items you are unable or unwilling to perform.

Review the list below and check only those items you are unable or unwilling to perform.
  • Unloading merchandise weighing up to 50 lbs. from pallets
  • Identifying, sorting, and recording products
  • Loading products weighing up to 50 lbs. on to display units
  • Loading, operating, and unloading hand trucks and electric pallet jacks and, in some instances, forklifts. (We train and certify power equipment operators.)
  • Lifting and carrying product weighing up to 50# around the store and to customers’ vehicles
  • Typing on a keyboard
  • Cleaning the facility and products which involves handling cleaning products and equipment.
  • Handling pets that visit the store
  • Reading, writing, and arithmetic (including percentages)
More specifically, the job requires that you be able to do the following:
  • Stand on concrete- 70% of your day
  • Walk-30% of your day
  • Bend- frequently
  • Squat/crouch- frequently
  • Twist- occasionally
  • Kneel- occasionally
  • Crawl- rarely
  • Reach- frequently
  • Balance- occasionally
  • Push- occasionally
  • Pull- occasionally
  • Climb- occasionally
  • Lift up to 50 lbs.- frequently
  • Carry up to 50 lbs.- frequently
  • Perform fine and gross manipulation- frequently
  • Grasp and use power grip- occasionally
  • Exercise eye-to-hand coordination- occasionally
  • Talk- frequently
  • Hear- to communicate with customers. Other means acceptable
  • See- to recognize products and navigate safely.
  • Color vision- not required.
  • Depth perception - required
1. I have read the list of job functions above and am willing and able to perform the duties described. Yes No
2. If no, I have checked the boxes of the job functions listed above that I am unable or unwilling to perform. If no, what reasonable job accommodation(s) could Pet Food Express make to enable you to perform these duties?

BY CHECKING THE BOX MY NAME BELOW, I CERTIFY THAT I HAVE READ, UNDERSTOOD, AND ACCEPTED THE POLICIES AND PROVISIONS LISTED IN THIS FORM. YOU MAY BE ASKED TO SIGN THIS DOCUMENT IF GRANTED AN INTERVIEW.
Name: Date:
Signed:  
References

Minimum of 3 professional references – 5 for management

(Immediate supervisors and managers preferred)

Reference #1
Reference #2
Reference #3
Reference #4
Reference #5
Submit Your Completed Application
Notice to Applicant: We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, sexual orientation, national origin, citizenship, age, physical or mental disability, or any other characteristics. The information in this application will not be the only basis for hiring decisions. You are not required to furnish any information that is prohibited by federal, state, or local law.

Complete? Page
#1 Personal Information
#2 Business Experience
#3 Education and Skills
#4 History
#5 Background Check
#6 Physical Requirements
#7 References


Enter the hours you can work on each week day.
Example: 8am - 5pm
Day From To
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday




If "other" please specify:
1st Choice 2nd Choice
3rd Choice 4th Choice
Firm Name Address (Street, City, St, Zip) Phone:
Kind of Business Dates
From: To:
Title Initial Pay Rate Final Pay Rate
Principal Duties
Name and Title of immediate supervisor Phone
What do/did you like most about this job?
What do/did you like least?
Reason(s) for leaving
Firm Name Address (Street, City, St, Zip) Phone:
Kind of Business Dates
From: To:
Title Initial Pay Rate Final Pay Rate
Principal Duties
Name and Title of immediate supervisor Phone
What do/did you like most about this job?
What do/did you like least?
Reason(s) for leaving
Firm Name Address (Street, City, St, Zip) Phone:
Kind of Business Dates
From: To:
Title Initial Pay Rate Final Pay Rate
Principal Duties
Name and Title of immediate supervisor Phone
What do/did you like most about this job?
What do/did you like least?
Reason(s) for leaving
Firm Name Address (Street, City, St, Zip) Phone:
Kind of Business Dates
From: To:
Title Initial Pay Rate Final Pay Rate
Principal Duties
Name and Title of immediate supervisor Phone
What do/did you like most about this job?
What do/did you like least?
Reason(s) for leaving
School Name and Locaction Graduate? Degree(s) Obtained
High School(s)
College(s)
Universities
Major:
Trade, Business,Professional
MS Windows
MS Outlook
MS Excel
MS Word
Pet Type Knowledge Level
Dog Explain:
Cat Explain:
Fish Explain:
Bird Explain:
Small Mammal Explain:
Reptile Explain:
Other Explain:
Type of Reference:
Professional
School
Name: Phone:
E-mail: Alt Phone:
Is this reference a relative?
Yes
No 		How long have you known or worked with this reference?
How do you know this reference? (indicate company for supervisors or co-workers)
Type of Reference:
Professional
School
Name: Phone:
E-mail: Alt Phone:
Is this reference a relative?
Yes
No 		How long have you known or worked with this reference?
How do you know this reference? (indicate company for supervisors or co-workers)
Type of Reference:
Professional
School
Name: Phone:
E-mail: Alt Phone:
Is this reference a relative?
Yes
No 		How long have you known or worked with this reference?
How do you know this reference? (indicate company for supervisors or co-workers)
Type of Reference:
Professional
School
Name: Phone:
E-mail: Alt Phone:
Is this reference a relative?
Yes
No 		How long have you known or worked with this reference?
How do you know this reference? (indicate company for supervisors or co-workers)
Type of Reference:
Professional
School
Name: Phone:
E-mail: Alt Phone:
Is this reference a relative?
Yes
No 		How long have you known or worked with this reference?
How do you know this reference? (indicate company for supervisors or co-workers)