Humane Society of Washington County, Maryland

Job Application Form

Downloadable Version - Click Here

* denotes required field

* Full Name:

Position Desired:

* Address:

* City:

* State:

County:

Zip:

Work phone:

Cell phone:

* Email address:

Age:

Education

School & Location Graduation Date

High School:

College:

Other Training Skills:

Employee History

List Below, our last three places of employment

Employer1:

Start Date:
End Date:
Employer:
Address:
Duties:

Employer2:

Start Date:
End Date:
Employer:
Address:
Duties:

Employer3:

Start Date:
End Date:
Employer:
Address:
Duties:

If you are currently employed, may we contact your employer?

Have you ever been convicted of a crime?

If "yes" please explain:

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?

References

References1:

Name:
Address:
Phone:
Knows you from:

Employer2:

Name:
Address:
Phone:
Knows you from:

Employer3:

Name:
Address:
Phone:
Knows you from:

Days and Hours NOT Available:

Why are you interested in working with the Humane Society of Washington County:

Image Verification:
(Type word as shown below)

I certify that all the information submitted by me on this application is true and correct, and I understand that if any false information, omissions, or misrepresentations are discovered, my application will be rejected and if I am employed that my employment will be terminated.

* Signed (your name) Date