WAG-A-LOT

The WAG-A-LOT Company and WAG-A-LOT Ventures, Inc. (the “Company”) is an equal opportunity employer and will not base hiring on race, color, sex, national origin, religion, disability, age, sexual orientation, or any other characteristic protected by applicable federal, state, or local law. No question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on any basis prohibited by federal, state or local laws. It is the Company’s policy not to refuse to hire a qualified individual with a disability because of that person’s need for a reasonable accommodation as provided under the Americans with Disabilities Act or other applicable laws.

PLEASE FILL IN YOUR RESPONSES BELOW. YOU MUST COMPLETE ALL INFORMATION ON THIS APPLICATION FOR EMPLOYMENT.

Name:		Date:
Available start date:		Location:
Type of employment:
Position:

Phone (Home):		SS #:
Phone (Work):		E-mail:
Phone (Cell):

Present Address Line 1:		City:
Present Address Line 2:		State:
		Zip:

Permanent Address Line 1: (if different)		City:
Permanent Address Line 2:		State:
		Zip:

Have you ever been employed or enrolled in school under a name other than that used on this application? If so, please specify.
If you are under 18, can you furnish a work permit?
Ever applied to this Company before? (Where and When)
Any family members work for this Company? (Who, relation)
Are you legally authorized to work in this country?
Have you ever pled “guilty” or “no contest” to or been convicted of a felony within the past 7 years?
Are you able to perform the essential functions for which you are applying with or without a reasonable accommodation?
Are you presently employed?
If yes, may we contact your current employer?
How did you learn about our employment opportunities?

Educational Background

	Years Completed	Graduate?	Courses of Study	Degree
High School
College
Other (Trade, Graduate)

Work Experience
(list former employers, starting with most recent)

(1)
Company Name:		Start Date:
Company Address:		End Date:
City:		Position:
State:		Supervisor Name/Title:
Zip:
Duties & Responsibilities:		Starting Pay:
Reason for Leaving:		Ending Pay:

(2)
Company Name:		Start Date:
Company Address:		End Date:
City:		Position:
State:		Supervisor Name/Title:
Zip:
Duties & Responsibilities:		Starting Pay:
Reason for Leaving:		Ending Pay:

(3)
Company Name:		Start Date:
Company Address:		End Date:
City:		Position:
State:		Supervisor Name/Title:
Zip:
Duties & Responsibilities:		Starting Pay:
Reason for Leaving:		Ending Pay:

(4)
Company Name:		Start Date:
Company Address:		End Date:
City:		Position:
State:		Supervisor Name/Title:
Zip:
Duties & Responsibilities:		Starting Pay:
Reason for Leaving:		Ending Pay:

References
(List three professional references who are not relatives. If no work history,
list three school or personal references who are not relatives)

	Name	Company	City/State/Phone
(1)
(2)
(3)

I hereby certify that the information contained on this application, or any other information I submit to the Company in connection with my application for employment, is true and correct to the best of my knowledge and agree to have any such statements or information checked by the Company. I authorize the Company to make a thorough investigation of my references, past employment, education, criminal background, and to secure additional job-related information about me. I also authorize the references listed above, as well as all other individuals whom the Company contacts, to provide the Company with any and all information concerning my previous employment and any other pertinent information that they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the Company as well as from any use or disclosure of such information by the Company or any of its agents, employees or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application, or any other information I submit to the Company in connection with my application for employment, may result in my failure to receive an offer or, if I am hired, my immediate dismissal from employment.

This application is current for only 90 days. At the conclusion of this time, if have not heard from the Company and still wish to be considered for employment, I understand that it will be necessary for me to complete a new application.

I understand that if I am hired by the Company, my employment will be “at-will” and, just as I will be free to resign at any time, the Company reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no employee or representative of the Company has any authority to enter into a contract of employment, express or implied, that changes or modifies in any way such employment at-will.

By filling in the signature box (to the right) with your name and pressing the “Submit” button at the bottom of this page, you agree to the terms & conditions above:
	Signature	Date