The Canine Empire, LLC
120 N. LaSalle Street
38th Floor
Chicago, IL 60602
THIS PRE-EMPLOYMENT QUESTIONNAIRE IS STRICTLY FOR THE PURPOSE OF HELPING THE CANINE EMPIRE MAKE HIRING DECISIONS. FOR THIS REASON, IT IS IMPORTANT THAT YOU COMPLETE THIS APPLICATION COMPLETELY AND TRUTHFULLY.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. WE DO NOT DISCRIMINATE WITH REGARD TO AGE, RACE, SEX, RELIGION, COLOR, NATIONAL ORIGIN, SEXUAL ORIENTATION, DISABILITY, OR ANY OTHER PROTECTED STATUS UNDER APPLICABLE LOCAL, FEDERAL OR STATE LAW.
PERSONAL INFORMATION
Street Address
City
State
Zip
Phone
Alternate Phone
E-mail Address
Social Security Number
Are you 16 years of age or older?
yes
no
Are you 21 years of age or older?
yes
no
Are you legally authorized for employment in the United States?
yes
no
(Upon hire, you will be required to provide proof of identification and authorization to work.)
Are you seeking full- or part-time employment?
Full-time
Part-time
Canine Empire is open around the clock, every day of the year. Many positions require staffing for three shifts. Please list days of the week and hours that you will be available to work.
EMPLOYMENT DESIRED
For what position(s) are you applying?
If you are hired, when would you be able to start work?
Salary/Wage desired?
How did you learn about this job?
Employment Agency
Name
Newspaper
Name
Internet
School
Name
Other
Please Specify
EMPLOYMENT HISTORY
List your previous experience beginning with your most recent position. Please denote any employer or supervisor you do not want contacted at this time.
1. EMPLOYER
Dates Employed
From
To
Street Address
City
State
Zip
Phone
Starting Position
Starting Salary
Last Position
Final Salary
Immediate Supervisor
Duties
Reason For Leaving
2. EMPLOYER
Dates Employed
From
To
Street Address
City
State
Zip
Phone
Starting Position
Starting Salary
Last Position
Final Salary
Immediate Supervisor
Duties
Reason For Leaving
3. EMPLOYER
Dates Employed
From
To
Street Address
City
State
Zip
Phone
Starting Position
Starting Salary
Last Position
Final Salary
Immediate Supervisor
Duties
Reason For Leaving
4. EMPLOYER
Dates Employed
From
To
Street Address
City
State
Zip
Phone
Starting Position
Starting Salary
Last Position
Final Salary
Immediate Supervisor
Duties
Reason For Leaving
EDUCATION
COLLEGE(S) TRADE OR VOCATIONAL SCHOOLS
School Name
Location of School
Major Course of Study
Did You Graduate?
Yes
No
No. Of Years Completed
Type Of Degree, Diploma Or Certification
HIGH SCHOOL
School Name
Location of School
Major Course of Study
Did You Graduate?
Yes
No
No. Of Years Completed
Type Of Degree, Diploma or Certification
RELEVANT JOB SKILLS (experience with animals or animal care)
OTHER PERSONAL HISTORY
Have you ever been convicted of any violations of the law? (Do not include minor traffic offenses.)
(Note that a conviction record is not an absolute bar to employment but will be considered only if job related.)
Yes
No
If yes, state details and dates
Have you ever been disciplined for attendance problems?
Yes
No
If yes, please explain
For the sole purpose of searching Criminal or Credit records, the following must be completed:
Driver's License Number
State Of Issue
State ID Card Number
State Of Issue
Current Address
City
State
Zip
How long at this address?
Previous Address
City
State
Zip
How long at this address?
I certify that the information contained in the application is accurate and complete to the best of my knowledge and belief. I understand that any misrepresentation of fact, as stated or implied, given in my application, interview(s) or any other employment form may be sufficient reason to not hire me or may be reason for dismissal.
I authorize investigation and verification of all statements and information contained herein or in any other employment form or obtained during an interview, with all individuals and organizations contained therein and any consumer reporting agency or law enforcement agency in conjunction with the Federal Fair Credit Reporting Act or other applicable law. I further release all parties including the Club, from any and all liability that may result from said investigation and verification, except such claims which cannot be waived by law.
I further agree to follow the Club's drug and alcohol policy and I understand and agree that I may be subject to drug and alcohol testing for reasonable cause. I further agree that if I violate the Club's drug and alcohol policy, I may be subject to discipline, up to and including termination of employment. I understand that the Club is not obligated to provide employment and that I am not obligated to accept employment. Nothing in this application or in any prior or subsequent oral or written statement or communication, is intended to create any contract of employment or to create any rights in the nature of a contract. I also understand that no one has the authority to enter into an agreement, contract, or modification of the understandings expressed in this statement unless it is written and signed by an authorized officer of the Club. I understand that, if hired, my employment is for no definite period. I further understand that if hired, I will be an employee at will and my employment can be terminated at any time, for any reason, with or without cause, without prior notice.
I hereby acknowledge that I have read the above statements and I understand and accept them.
Signature:
Date:
NOTICE REGARDING BACKGROUND INVESTIGATION
IMPORTANT – PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGEMENT
The Canine Empire LLC ( the Club ) may, upon execution of this authorization, investigate the information contained in your employment application and/or other background information to determine whether you are a suitable candidate for employment. Thus, you may be the subject of a consumer report requested by the Club from an outside agency. This report may be obtained immediately upon your authorization or at any time during your employment. A consumer report may contain information obtained from an outside agency on your creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and mode of living which will be used to establish your eligibility for employment. In the event that information from the report is utilized in whole or in part, in making an adverse employment decision, before making an adverse decision, the Club will provide you with a copy of your consumer report and a description in writing of your rights under the Fair Credit Reporting Act.
ACKNOWLEDGEMENT AND AUTHORIZATION
I acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION and certify that I have read and understand this form.
I hereby authorize The Canine Empire LLC to obtain a consumer report upon receipt of this authorization or at any time during my employment.
