Tulsa SPCA Employment Application

Date of Application*

PERSONAL INFORMATION

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Referred by

Are you 18 years of age or older?*

Yes
No

If hired, can you furnish proof of eligibility to work in the U.S. (photo ID or Social Security card)?*

Yes
No

Position Desired

Date you can start?*

Salary Desired*

Employment Desired*

Part Time
Full Time

What days of the week you are UNAVAILABLE to work?*

Select all that apply.

Are you currently employed?*

Yes
No

If currently employed, may we inquire of your present employer?

Yes
No

EDUCATION

Name, city and state of grammar school

Years attended

Did you graduate from grammar school?*

Yes
No

Subjects studied

Name, city and state of high school

Years attended

Did you graduate from high school?*

Yes
No

Subjects studied

Name, city and state of college or university

Years attended

Did you graduate from college?*

Yes
No

Subjects studied

WORK HISTORY

List previous employers beginning with the most recent.

Company Name #1

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Employment Dates

Name of supervisor

Weekly pay

Job title and description

Reason for leaving

What did you like most about this job?

What did you like least about this job?

Company Name #2

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Employment Dates

Name of supervisor

Weekly pay

Job title and description

Reason for leaving

What did you like most about this job?

What did you like least about this job?

Company Name #3

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Employment Dates

Name of supervisor

Weekly pay

Job title and description

Reason for leaving

What did you like most about this job?

What did you like least about this job?

REFERENCES

Reference #1*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Your relationship to reference (friend, co-worker, etc.)*

Years Known*

Reference #2*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Your relationship to reference (friend, co-worker, etc.)*

Years Known*

Reference #3*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Your relationship to reference (friend, co-worker, etc.)*

Years Known*

Have you ever been convicted of any law violation, excluding minor traffic violations?*

Yes
No

If yes, please explain, listing city/state

AFFIDAVIT, CONSENT AND RELEASE

Please read each statement carefully before signing.

Signature*

I have read and understand the consent statements listed above.