Apply Employment Application Personal InformationName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneAlternate PhoneEmail Address* Position*Available Start Date* Date Format: MM slash DD slash YYYY Salary DesiredAre you currently employedPlease SelectYesNoHave you ever applied for a job at HSHA before?Please SelectYesNoEducationHigh SchoolName and Location of School# of Years AttendedDid You Graduate?Please SelectYesNoCollegeName and Location of School# of Years AttendedDid You GraduatePlease SelectYesNoTrade, Business or Correspondence SchoolName and Location of School# of Years AttendedDid You GraduatePlease SelectYesNoReferences Please include the names of 3 persons you are not related to, whom you have known for at least 1 year1st ReferenceNameAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code BusinessYears Acquainted2nd ReferenceNameAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country BusinessYears AcquaintedService RecordBranch of ServiceDischarge Date & RankCriminal RecordHave you ever been convicted of a felony within the last 5 years? Yes No If yes, please explain(Will not necessarily exclude you from consideration)Former Employers *List below last three employers, starting with the most recent one firstCompany NamePhone NumberAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor NameTitleStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Job TitleStarting SalaryHourly / AnnuallyEnding SalaryHourly / AnnuallyDescription of Work:Type of Position Full-time Part-time Contract/Temporary Intern Reason for LeavingHours / WeekCan this employer be contacted?YesNoDuties Performed / ResponsibilitiesCompany NamePhone NumberAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor NameTitleStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Job TitleStarting SalaryHourly / AnnuallyEnding SalaryHourly / AnnuallyDescription of Work:Type of Position Full-time Part-time Contract/Temporary Intern Reason for LeavingHours / WeekCan this employer be contacted?YesNoDuties Performed / ResponsibilitiesCompany NamePhone NumberAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor NameTitleStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Job TitleStarting SalaryHourly / AnnuallyEnding SalaryHourly / AnnuallyDescription of Work:Type of Position Full-time Part-time Contract/Temporary Intern Reason for LeavingHours / WeekCan this employer be contacted?YesNoDuties Performed / ResponsibilitiesHave you ever brought an animal to a shelter? If so, under what circumstances? Please list all animals currently ownedTypeSexAgeTime OwnedSpayed/Neutered?Kept Where? (Inside/Outside)+- Please list any pets owned in the last 10 years, other than those listed aboveTypeSexAgeTime OwnedSpayed/Neutered?Where is it now?+-Do you feel that cats should be allowed to go outside? Please explain.What is your viewpoint on declawing cats? Please explain.Do you feel that dogs are happier when kept inside, outside, or a combination of both? Please explain.What are your views on spaying/neutering? If you support it, why and for what animals (purebreads, mixed breeds, shelter animals, all animals, etc.)This shelter is one in which euthanasia (humane death) is performed under specific circumstances. How do you feel about euthanasia in general?Would you be able to work in an environment where euthanasia is performed?If we should offer you this position, what would your expectations be about this job? Why do you want to work at an animal shelter? What do you hope to gain by working here?Do you have any prior experience/education at an animal shelter or in a related field?Do you have any allergies to animals?The Humane Society of Harrisburg is not only animal related, but it also involves constant contact with the general public. How do you feel about interacting with all types of people?Are there any restrictions that would prevent you from lifting up to 50 pounds? If yes, please explain why.Do you have the ability to perform the duties of the job for which you are applying without a reasonable accommodation? If no, please explain.Cover LetterResume*
