Print this application, complete it and mail the completed form to:
Animal Friends of Barbour County
c/o Kimberly J. Delauder
2431 Morgantown Pike
Belington WV 26250
ANIMAL FRIENDS OF BARBOUR COUNTY, INC.
APPLICATION FOR EMPLOYMENT
It is our policy to provide equal employment opportunity to all qualified persons without regard
to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental handicap,
or veteran status.
Date:
Name: Last First Middle
Street Address
City State Zip
Telephone (Home) (Cell)
Social Security # WV Driver's License #
Position applied for
How did you hear of this opening?
When can you start?
Are you a U.S. citizen or otherwise authorized to work in the U.S. on unrestricted basis? Yes No
Do you understand that this is a part time position? Yes No
Are you available to work in the evenings? Yes No
Have you ever been convicted of a felony? Yes No
If yes, please fully describe the circumstances:
Education: School Name Location Year Graduated
High School
College
Other
In addition to your work history, are there are other skills, qualifications
or experience we should consider:
Employment History: (Start with most recent employer.)
Company Name
Address Telephone
Date Started Starting Wage Starting Position
Date Ended Ending Wage Ending Position
Name of Supervisor May we contact: Yes No
Responsibilities
Reason for leaving
Attach additional employment information if necessary.
I certify that the facts set forth in this application for employment are true and complete
to the best of my knowledge. I understand that if I am employed, false statements on this
application shall be considered sufficient cause for dismissal. Animal Friends is hereby
authorized to make any investigations of my prior education and employment history.
I understand that employment with Animal Friends is "at will," which means that either
I or Animal Friends can terminate the employment relationship at any time, with
or without prior notice, and for any reason not prohibited by statute.
Signature Date
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