Akron Zoological Park, 500 Edgewood Avenue, Akron, OH 44307-2199
APPLICATION FOR EMPLOYMENT
As an EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER, Akron Zoological Park does not discriminate against
applicants or employees because of their age, race, color, religion, national origin, sex or on any other basis prohibited by
law. Furthermore, Akron Zoological Park will not discriminate against any applicant or employee because he or she is
mentally or physically handicapped, a disabled veteran, a veteran of the Vietnam era, or has a non-job related medical
condition, provided he or she is qualified and meets the requirements established by Akron Zoological Park for the job.
NAME
(Last)
(First)
PLEASE PRINT OR TYPE
(Middle)
CURRENT ADDRESS
(Street)
(City)
(State)
(Zip)
PHONE NUMBER
PREVIOUS ADDRESS
(Street)
(City)
(State)
(Zip)
HOW LONG?
(Street)
(City)
(State)
(Zip)
HOW LONG?
(within past 10 years)
PREVIOUS ADDRESS
(within past 10 years)
POSITION APPLIED FOR
TYPE OF POSITION DESIRED
 FULL TIME
SALARY EXPECTED
 PART TIME
HAVE YOU EVER WORKED FOR THE AKRON ZOO?
 YES  NO
HAVE YOU EVER APPLIED TO THE AKRON ZOO?
 YES  NO
HOW WERE YOU REFERRED TO THE AKRON ZOO?
 SUMMER
 TEMPORARY
 OTHER
IF YES, WHEN?
IF YES, WHEN?
IF YOU ARE NOT A U.S. CITIZEN, DO YOU HAVE A VISA WHICH PERMITS YOU TO WORK IN THE U.S.?
 YES  NO
IF YES, WHAT KIND OF VISA?
VISA REGISTRATION NUMBER
EXPIRATION DATE
HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE PAST FIVE YEARS?
IF YES, PLEASE EXPLAIN
(Where)
(When)
(Charge)
 YES  NO
(Sentence)
(Disclosure of a criminal record will not necessarily disqualify you for employment. Each conviction will be evaluated on
its own merits with respect to time, circumstances and seriousness relative to the job for which you are applying.)
RECORD OF EDUCATION
Name and address of school:
HIGH SCHOOL
(Last attended)
COLLEGES/
UNIVERSITIES
Highest Grade
Completed
Do not
complete
this box.
Graduated?
Type of
degree/
diploma
Major/Minor Fields
Of Study
 YES
 NO
 YES
 NO
GRADUATE SCHOOL
 YES
 NO
OTHER
(Business,
technical,
secretarial, etc.)
 YES
 NO
DO YOU BELONG TO AN ORGANIZATION OR PROFESSIONAL SOCIETY WHICH HAS A BEARING UPON YOUR
QUALIFICATIONS FOR THE JOB YOU ARE SEEKING?
 YES  NO
IF SO, PLEASE DESCRIBE:
DO YOU HAVE ANY HOBBIES, INTERESTS, SPECIAL SKILLS OR ABILITIES WHICH RELATE TO THE JOB YOU
ARE SEEKING? PLEASE DESCRIBE:
IF THE POSITION FOR WHICH YOU ARE APPLYING REQUIRES THE OPERATION OF A MOTOR VEHICLE, DO YOU
POSSESS A VALID CURRENT DRIVERS LICENSE?
 YES  NO
DRIVERS LICENSE NUMBER AND STATE: __________________________________________________________
MILITARY SERVICE RECORD
HAVE YOU EVER BEEN A MEMBER OF THE ARMED FORCES OF THE U.S.?
 YES  NO
IF YES, DID YOU DEVELOP ANY SPECIAL SKILLS OR ABILITIES WHICH RELATE TO THE JOB YOU ARE
SEEKING? PLEASE DESCRIBE:
EMPLOYMENT EXPERIENCE
1. NAME AND ADDRESS
OF EMPLOYER
STARTING
POSTION: _______________________________
__________________________________
STARTING DATE: __________________________
__________________________________
STARTING SALARY: $ ______________________
__________________________________
ENDING
POSITION: _______________________________
PHONE (
NAME AND TITLE OF LAST
SUPERVISOR:
REASON FOR LEAVING:
) ____________________
ENDING DATE: ___________________________
MAY WE CONTACT THE EMPLOYER?
 YES
 NO
2. NAME AND ADDRESS
OF EMPLOYER
ENDING SALARY: $ _______________________
STARTING
POSTION: _______________________________
__________________________________
STARTING DATE: __________________________
__________________________________
STARTING SALARY: $ ______________________
__________________________________
ENDING
POSITION: _______________________________
PHONE (
NAME AND TITLE OF LAST
SUPERVISOR:
REASON FOR LEAVING:
) ____________________
ENDING DATE: ___________________________
MAY WE CONTACT THE EMPLOYER?
 YES
 NO
3. NAME AND ADDRESS
OF EMPLOYER
ENDING SALARY: $ _______________________
STARTING
POSTION: _______________________________
__________________________________
STARTING DATE: __________________________
__________________________________
STARTING SALARY: $ ______________________
__________________________________
ENDING
POSITION: _______________________________
PHONE (
NAME AND TITLE OF LAST
SUPERVISOR:
REASON FOR LEAVING:
) ____________________
ENDING DATE: ___________________________
MAY WE CONTACT THE EMPLOYER?
 YES
 NO
4. NAME AND ADDRESS
OF EMPLOYER
ENDING SALARY: $ _______________________
STARTING
POSTION: _______________________________
__________________________________
STARTING DATE: __________________________
__________________________________
STARTING SALARY: $ ______________________
__________________________________
ENDING
POSITION: _______________________________
PHONE (
) ____________________
ENDING DATE: ___________________________
MAY WE CONTACT THE EMPLOYER?
 YES
 NO
ENDING SALARY: $ _______________________
NAME AND TITLE OF LAST
SUPERVISOR:
REASON FOR LEAVING:
REFERENCES
LIST THREE PERSONS WHO ARE FAMILIAR WITH YOUR PROFESSIONAL ABILITIES. OMIT RELATIVES.
NAME ________________________
NAME ________________________
NAME ________________________
ADDRESS _____________________
ADDRESS _____________________
ADDRESS _____________________
OCCUPATION __________________
OCCUPATION __________________
OCCUPATION __________________
PHONE ________________________
PHONE ________________________
PHONE ________________________
TO BE READ AND SIGNED BY APPLICANT
THIS CERTIFIES THAT THIS APPLICATION WAS COMPLETED BY ME, AND THAT ALL ENTRIES ON IT AND
INFORMATION IN IT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND AND
AGREE THAT ANY MISREPRESENTATION OR OMISSION OF FACTS IN MY APPLICATION MAY BE JUSTIFICATION
FOR REFUSAL TO HIRE, OR TERMINATION OF EMPLOYMENT.
I WARRANT THAT I AM NOT CURRENTLY A PARTY TO ANY AGREEMENT WHICH MAY LIMIT MY ABILITY TO
PERFORM THE POSITION FOR WHICH I AM APPLYING.
I FURTHER UNDERSTAND THAT AN INVESTIGATIVE REPORT MAY BE MADE AS TO MY CHARACTER AND
GENERAL REPUTATION. I AUTHORIZE ALL PAST EMPLOYERS, SCHOOLS, PERSONS AND ORGANIZATIONS
HAVING RELEVANT INFORMATION OR KNOWLEDGE TO PROVIDE IT TO THE AKRON ZOOLOGICAL PARK OR
ITS DULY AUTHORIZED REPRESENTATIVE, FOR ITS USE IN DECIDING WHETHER OR NOT TO OFFER ME
EMPLOYMENT AND SPECIFICALLY WAIVE ANY REQUIRED WRITTEN NOTIFICATION. I HEREBY RELEASE
EMPLOYERS, SCHOOLS, PERSONS AND ORGANIZATIONS FROM ALL LIABILITY IN RESPONDING TO INQUIRIES
IN CONNECTION WITH MY APPLICATION.
I AGREE THAT IF I AM EMPLOYED BY THE AKRON ZOOLOGICAL PARK, THE EMPLOYMENT WILL BE
EMPLOYMENT AT WILL, AND EITHER I OR THE AKRON ZOOLOGICAL PARK MAY TERMINATE THE
EMPLOYMENT RELATIONSHIP AT ANY TIME FOR ANY REASON WITHOUT NOTICE, AND THIS APPLICATION
SHALL BE A PART OF MY TERMS OF EMPLOYMENT.
IN SIGNING THIS FORM, I CERTIFY THAT I UNDERSTAND ALL OF THE QUESTIONS AND STATEMENTS IN THE
APPLICATION.
____________________________________________
SIGNATURE OF APPLICANT
______________________________
DATE
Applicant Release for Background Investigation
Confidential Information for Human Resources Department Only
I hereby authorize Akron Zoological Park (hereafter referred to as the Akron Zoo) or its agent, IntelliCorp Records, Inc., to
investigate my background in order to process my application for employment.
I understand the consumer reporting agency will conduct an investigation to obtain information as deemed necessary to fulfill the
requirements of the job. The information obtained may include investigation into the last seven (7) years of my credit background
and beyond seven (7) years regarding my past employment, work habits, salary history, education, criminal background, motor
vehicle history, workers’ compensation history, civil records, use of illegal substances and alcohol abuse, personal characteristics,
mode of living, and general reputation.
I understand direct or indirect contact from former employers, schools, financial institutions, landlords, public agencies, and through
personal interviews with my associates, friends, acquaintances, neighbors, or other persons who may have such knowledge may
be made to obtain such information.
I forever release and discharge Akron Zoo, IntelliCorp Records, Inc., their respective employees and agents, my past employers,
schools, persons named in my employment application or resume from any claims, damages, losses, liabilities, and expenses
arising out of gathering and reporting information.
I also understand that before being denied employment based on information obtained in the report, I will be provided a copy of the
report and a description in writing of my rights under the Fair Credit Reporting Act.
I understand I may request an outline of the nature and scope of the investigation if such request is made in writing within a
reasonable period after the completion of the investigation. The address of IntelliCorp Records, Inc., 3000 Auburn Drive, Suite 410,
Beachwood, OH 44122, and their telephone number is (800) 539-3717.
PLEASE FILL IN EACH BLANK SPACE
FIRST NAME:
MIDDLE INITIAL:
LAST NAME:
FORMER LAST NAME OR MAIDEN NAME:
SOCIAL SECURITY #:
DRIVER’S LICENSE #:
PHONE:
STATE:
CURRENT ADDRESS:
PREVIOUS ADDRESS:
CITY:
CITY:
STATE:
ZIP:
STATE:
COUNTY:
ZIP:
COUNTY:
LENGTH OF RESIDENCE:
YEARS:_____ MONTHS:_____
LENGTH OF RESIDENCE:
YEARS:_____ MONTHS:_____
DATE OF BIRTH:
HAVE YOU EVER BEEN CONVICTED OF A CRIME?
MAY WE CONTACT YOUR CURRENT EMPLOYER?
____ YES
_____ YES
CITY: ___________________________
____ NO
____ NO
IF YES, APPROX. DATE: _____________
STATE: ______________
Description of Offense: _______________________________________
_______________________________________________________
In addition to authorizing the background investigation, I certify that the information I have provided is true and complete, and
I understand that if I am employed, false or incomplete statements of material fact on this authorization shall be sufficient
cause for dismissal.
SIGNATURE
DATE
Akron Zoo is an equal opportunity employer and does not discriminate against applicants or employees on the basis of
sex, race, color, religion, national origin, ancestry or age (40 years of age and over). In addition, Akron Zoo does not
discriminate against qualified individuals with disabilities.