Please answer all questions. Resumes are not a substitute for a
 completed application

***We are an equal opportunity employer. Applicants are considered for
 positions without regard to race, religion, sex, national origin, age,
 disability, or any other consideration made unlawful by applicable federal,
 state, or local laws.***

 Position Applied For:
 

 Which Location would you prefer?
  East Providence Warwick

 Name:                                                  Telephone:
          

 Present Address: (Street, Apt, or Unit #)        Email:
      

 City, State, Zip
     

       

 Are you able at the time of employment to submit verification of
 your legal right to work in the U.S.? (Verification and completion of
 Form I-9 must be submitted no later than three business days after
 date of hire.)
 Yes: No:

 If under the age of 18, can you produce the necessary work certificate
 at the time of employment?
 Yes: No:

       

 Desired Salary:
 

 Type of Employment Desired:      Specific Hours:
  Full-Time: Part-Time:         

 Are you willing to work overtime? Yes: No:

 Have You Applied Here Before? Yes:  No:

       

Within the past ten (10) years, have you been convicted of a felony?
 (Do not include convictions that were sealed, eradicated, erased, or
 expunged; convictions that have resulted in referral to a diversion
 program; or marijuana-related convictions that are more than two (2)
 years old.)
 Yes: No:

 If Yes, please explain so that individual circumstances can be considered.
 

 Note: Criminal convictions will not automatically disqualify an applicant
  from a particular job. The Company will consider the nature of the crime,
 its seriousness, whether the conviction(s) substantially relates to the
 position's functions and qualifications, the frequency of convictions, the
 applicant's age at the time of conviction, the time elapsed since the date of
 conviction or completion of jail sentence, the applicant's entire work and
 educational history, and employment references and recommendations. An
 ex-offender who is denied employment may, upon written request, receive a
 statement of the reason(s) for denial within 30 days of the applicant's request
 for such information.

 Have you ever initiated an act of violence in the workplace?
 Yes: No:

 If Yes, Please explain so that individual circumstances can be considered.
  (A Yes answer will not necessarily disqualify you from employment.)
 

       

 List special technical skills that you feel qualify you for the job for
 which you are applying (ie., computer programming / language, software,
 equipment operation, special tools or machines, etc):
 
  Education:

 High School:   Graduate?    #Years
   

 College:  Course of Study:   Graduate?   # Years:
      
 Degree:
 

 Bus / Tech / Trade School: Course of Study:   Graduate?   # Years:
    
 Degree:
 

       

 Work Experience:
 Start with your present or last place of employment. You
 may include any verifiable work performed on a volunteer basis,
 internship, or military service.

 Employer 1: 
 Address:    
 Type of Business:  Phone: 
 Dates Employed:
 From:  1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008  To:  1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

 Job Title:    

 Supervisor's Name: 
 May we Contact? Yes: No:

 Wages:
 Start: Final:

 Reasons for Leaving: 
 Duties: 

       

 Employer 2: 
 Address:    
 Type of Business:   Phone: 
 Dates Employed:
 From:  1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008  To:  1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

 Job Title:    

 Supervisor's Name: 
 May we Contact? Yes: No:

 Wages:
 Start: Final:

 Reasons for Leaving: 
 Duties: 

       

 Employer 3: 
 Address:    
 Type of Business:   Phone: 
 Dates Employed:
 From:  1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008  To:  1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

 Job Title:    

 Supervisor's Name: 
 May we Contact? Yes:  No:

 Wages:
 Start: Final:

 Reasons for Leaving: 
 Duties: 

       

 References:
 Please list the names of additional work-related references we may
 call. Individuals with no prior work experience may list school or volunteer
 related references.

 Reference 1:
 Name: 
 Position: 
 Company: 
 Relationship: 
 Telephone:

 Reference 2:
 Name: 
 Position: 
 Company: 
 Relationship: 
 Telephone:

       

 Applicant Certification:
 Please Click on the following link to read the
 Applicant Certification Statement

 I understand this Company hires only individuals who are legally
 eligible to work in the United States. Yes: No:

       

 If the applicant is a minor, the foregoing release and consent must be
 approved by the applicant's parent or legal guardian. Signature by the
 applicant's parent or legal guardian constitues acknowledgement by the
 applicant and the parent or legal guardian that the Company, to the
 extent permitted by federal, state, and local law, can test the
 applicant for controlled substances, conduct inspections of property
 without notice, and communicate screen results to Company personnel
 who need to know, the applicant, and the applicant's legal guardian.
 Upon further processing the parent and/or legal guardian need to be
 present for interview to sign the consent form.

 Full Name of Parent/Legal Guardian:

 Phone Number:

 I acknowledge the above statement.  Yes:  No:

       

 Self-Identification Form:

 Rumford Pet Center is an Equal Opportunity employer. As required by law,
 we must record certain information. Applicants for employment are also
 invited to participate by reporting their status as handicapped,
 disabled veteran, or other minority. In extending this invitation
 you are also advised that: (a) workers (applicants are under no
 obligation to respond, but may do so in the future if they choose;
 (b) responses will remain confidential within the human resources
 department; and (c) responses will be used only for the necessary
 information to include in our government reporting. Refusal to
 provide this information will have no bearing on your application
 and will not subject you to any adverse treatment.
 Thank you for your cooperation.

 Section 1: Please check all that apply
 Hispanic:  American Indian or Alaskan:  Asian:
 Native Hawaiian:  Black or African American:  White:

 Male:  Female:

 Individual with Disabilities:

       

 Thank you for your time to fill out this application

 Click Submit Below to Send this Application to Rumford Pet Center