SECURE Fresno Chaffee Zoo Corporation - Online Employment Application Powered by the Hush Encryption EngineTM

Applicant Information

Full Name:				Date:
	Last	First	M.I.

Address:
	Street Address	Apartment/Unit #
	City	State	Zip Code

Phone:

( )

E-mail Address:

Date Available:

Desired Salary: $

Position Applied for:

Are you a citizen of the U.S.?

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

Have you ever worked for this company?		Yes		No	If so, when?
Have you ever been convicted of a felony?		Yes		No

If yes, explain:

IF YOU ARE APPLYING FOR A POSITION THAT REQUIRES YOU TO DRIVE, YOU MUST HAVE A VALID DRIVER'S LICENSE AND ACCEPTABLE DRIVING RECORD.

Education

High School:

Address:

Did you graduate?

Yes

No

Degree:

College:

Address:

Did you graduate?

Yes

No

Degree:

Other School:

Address:

Did you graduate?

Yes

No

Degree:

References

Please list two professional references.

Full Name:

Relationship:

Company:

Phone:

( )

Address:

Full Name:

Relationship:

Company:

Phone:

( )

Address:

Previous Employment

Company:

Phone with area code:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?:

Yes

No

Company:

Phone with area code:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?:

Yes

No

Selective Service

Federal Law requires male U.S. citizens and aliens residing in the U.S. who are ages 18 through 25 to register with the Selective Service System. Please check if applicable:

	Yes	I have registered with the Selective Service System.	My Selective Service Number is:
	No	I have not registered with the Selective Service System.

	I am not required to register with the Selective Service System because I am exempt under the stated age/gender requirements.

Additional Remarks:

Availability

Monday

Tuesday

Wednsday

Thursday

Friday

Saturday

Sunday

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature:		Date: