Employee Application

Important Notice

IMPORTANT: Kiya Koda Humane Society operates seven days a week. Animal Care Attendant positions require employees to work weekends and holidays as part of their regular work schedule.

Applicant Initials: * By entering your initials, you acknowledge that you have read and understood the above notice.

Personal Information

Position Applying For: *

Full Name: *

Address: *

City: *

State: *

Zip: *

Phone: *

Email: *

Date of Birth: *

Date Available to Start: *

Are you at least 18 years old? *

Yes

No

Availability

Day	Available	Hours
Monday	Yes No
Tuesday	Yes No
Wednesday	Yes No
Thursday	Yes No
Friday	Yes No
Saturday	Yes No
Sunday	Yes No

Available to work holidays? *

Yes

No

Employment History

Employer 1

Employer:

Job Title:

Dates Employed:

Supervisor:

Phone:

Reason for Leaving:

Employer 2

Employer:

Job Title:

Dates Employed:

Supervisor:

Phone:

Reason for Leaving:

Employer 3

Employer:

Job Title:

Dates Employed:

Supervisor:

Phone:

Reason for Leaving:

Education

High School:

Graduate?

Yes

No

College/Trade School:

Animal Experience

Please describe any experience working with animals:

References

Name	Relationship	Phone

Upload Resume (Optional)

Accepted formats: DOC, DOCX, PDF, JPG (max 100MB)

Certification

I certify that the information provided on this application is true and complete to the best of my knowledge. I understand that any false or misleading information may result in disqualification from employment or termination if hired.

Applicant Signature (Typed Name): *

Date: *

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Employment Application

Important Notice

Personal Information

Availability

Employment History

Employer 1

Employer 2

Employer 3

Education

Animal Experience

References

Upload Resume (Optional)

Certification