David Baron's SuperDog, Inc.

Employment Application

Please fill out the form below and indicate the type of employment you are looking for.

* Indicates required fields

Employment Application:

Full Name:

*Last:

*First:

Middle:

Address:

City:

State: Zip:

Phone:

Mobile Phone:

*Email:

Date available to start:

Social Security #:

Salary Requirements:

If you are under 18 and we require a work permit, can you furnish one? Yes No

If Yes, when? If No explain:

Are you a citizen of the US? Yes No If not do you have work papers? Yes No

Type of employment desired: Full-time Part time Temporary Flex time

Have you ever pled "guilty" or "no contest" to or been convicted of a crime? Yes No

If "Yes" give dates and details:

Answering Yes to these questions does not constitute an automatic rejection to employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

Driver's license number if applicable to the position:

Education:

High School: Address:

# of years completed: Did you graduate? Yes No Degree: GPA:

College/University: Address:

# of years completed: Did you graduate? Yes No Degree: GPA:

Additional Education:

References:

Please furnish the names, address and phone numbers of two people to whom you are not related and by whom you have not been employed :

Name: Phone:

Address: City: State: Zip:

Name: Phone:

Address: City: State: Zip:

Summarize your special skills or qualifications:

Previous Employment: (begin with most recent positions)

Dates of Employment: From: To Position held:
Firm: Address:
Phone: Supervisor: Title:
Responsibilities:
Starting Salary and Title: Ending Salary and Title:
Reason for Leaving:
May we contact this employer for references? Yes No

Dates of Employment: From: To Position held:
Firm: Address:
Phone: Supervisor: Title:
Responsibilities:
Starting Salary and Title: Ending Salary and Title:
Reason for Leaving:
May we contact this employer for references? Yes No

Dates of Employment: From: To Position held:
Firm: Address:
Phone: Supervisor: Title:
Responsibilities:
Starting Salary and Title: Ending Salary and Title:
Reason for Leaving:
May we contact this employer for references? Yes No

Dates of Employment: From: To Position held:
Firm: Address:
Phone: Supervisor: Title:
Responsibilities:
Starting Salary and Title: Ending Salary and Title:
Reason for Leaving:
May we contact this employer for references? Yes No

I certify that my answers are true and complete to the best of my knowledge. I authorize Bartelt Education Center to make such investigations and inquiries of my personal, employment, educational, Financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from all liability in the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in my discharge. *Check this box to indicate you certify your answers: