423 North Main Street, Sycamore, IL 60178
815-899-3435
EMPLOYMENT APPLICATION
Date _______________
Name: ___________________________________________________________________
(Last)
(First)
(Middle)
Address ______________________________________________________________________
(Number & Street)
Phone ____________________
(City)
(State)
____________________
(Home)
(Zip code)
_____________________
(Cell)
(Fax)
E-Mail Address ________________________________________________________________
(Optional)
1. Do you have the legal right to work in the United States?
YES NO
 If hired by this firm, you must complete a I-9 form (Employment Eligibility Verification)
2. Are you at least 18 years of age?
YES NO
3. Since your 18th birthday, have you been convicted of a felony and/or related misdemeanor?
YES NO
 If yes, please list circumstances and provide dates. _______________________________
4. In case of emergency, Please list name and number __________________________________
5. What position are you applying for? _____________________________________________
6. If hired, when would you be able to start? _________________________________________
Please list your availability: Mon__________Tue__________Wed _________Thurs _________Fri__________
Sat ___________
Sun _________
Education and Training background:
High School ___________________________________________________________________
(Name)
(City & State)
(Years Completed)
(Graduation Year)
College (1) ___________________________________________________________________
(Name)
(City & State)
(Major)
(Years Completed)
(Degree)
College (2) __________________________________________________________________
(Name)
(City & State)
(Major)
(Years Completed)
(Degree)
Trade School __________________________________________________________________
(Name)
(City & State)
(Subject)
(Years Completed)
(Graduation Year)
7. Do you hold any special licenses or certificates? YES NO
If yes, please list ______________________________________________________________
8. Have you operated a cash register? YES/NO
9. Have you operated a credit card terminal? YES/NO
10. Have you operated a computer? YES/NO
If yes, what programs do you know?______________________________________________
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* If applying for a groomer or bather position, please complete the following questions:
1. Do you own any of the following equipment?
Blades YES/NO Clippers YES/NO Scissors YES/NO
2. Do you show dogs? YES/NO
* If you show dogs, please list the breeds: _________________________________________
3. Which breeds do you prefer not to groom? ________________________________________
4. Which breeds are your favorites to groom? _________________________________________
5. Do you groom cats? YES/NO
6. Have you operated a clipper vacuuming system? YES/NO
7. Have you operated a Shampoo Machine?
YES/NO
References: Please list 3 work related people that you have known for at least 1 year or more.
______________________________________________________________________________
(Name)
(Business Name & Job Position)
(Phone number)
______________________________________________________________________________
(Name)
(Business Name & Job Position)
(Phone number)
______________________________________________________________________________
(Name)
(Business Name & Job Position)
(Phone number)
Employment History: Please list your most present or recent employer first. If you are currently employed,
may we contact your employer? YES/NO If yes, please initial _____
1. ____________________________________________________________________________
(Employer)
(Address)
(City & State)
(Phone Number)
____________________________________________________________________________
(Supervisor)
(Dates of Employment)
(Job Title)
Please list job requirements and duties that you performed:
____________________________________________________________________________
____________________________________________________________________________
Reason for leaving: ____________________________________________________________
2. ____________________________________________________________________________
(Employer)
(Address)
(City & State)
(Phone Number)
____________________________________________________________________________
(Supervisor)
(Dates of Employment)
(Job Title)
Please list job requirements and duties that you performed:
____________________________________________________________________________
____________________________________________________________________________
Reason for leaving: ____________________________________________________________
3. ____________________________________________________________________________
(Employer)
(Address)
(City & State)
(Phone Number)
____________________________________________________________________________
(Supervisor)
(Dates of Employment)
(Job Title)
Please list job requirements and duties that you performed:
____________________________________________________________________________
____________________________________________________________________________
Reason for leaving: ____________________________________________________________
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Applicant: Please read and sign
I, ________________________, understand that this is an application for employment and
not an agreement or contract for employment. As part of the application process, I understand that I may
be required to demonstrate my grooming and/or brushing and bathing skills. I certify that all of the
statements provide in this application are true, complete, and correct to the best of my knowledge and
belief. I understand that the information I have provided may be verified and that falsification of
information may be ground for disqualification.
_____________________________________________
(Applicants signature)
____________________
(Date)
Office use:
Date Interviewed ______________
Verified
______________
Breed Groomed ______________
2nd Interview
_______________
Breed Groomed ______________
Score (1-10)
_______________
Reviewed By
_______________
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