Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Contact Number *

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Secondary Contact Number *

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Are you 18 years of age or older? *

Yes

No

Will you work overtime, if asked? *

Yes

No

Are you currently employed? *

Yes

No

Are you legally eligible for employment in the United States? *

Yes

No

May we contact them?

Yes

No

May we contact them? *

Yes

No

Have you been employed by Stray Hearts Animal Shelter previously? *

Yes

No

Have you been convicted of a crime in the past ten years? *

Yes

No

Can you perform the essential functions of the position you are applying for? *

Yes

No

Contact Number *

(###)

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Contact Number *

(###)

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Contact Number *

(###)

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