Pre-Employment Questionnaire

Step 1 of 3

33%

Your Personal Information

Your Name(Required)

First Last

Your Email Address(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Your Phone(Required)

Are you 18 years or older?

Yes

Desired Employment

Position you're applying for(Required)

Date you can start(Required)

MM slash DD slash YYYY

Salary Desired(Required)

Have you ever applied to LHS or LFACC before?(Required)

Yes

When?(Required)

Have you ever worked at LHS or LFACC before?(Required)

Yes

When?(Required)

Name of last supervisor at LHS or LFACC(Required)

Reason for Leaving(Required)

How did you hear about the position?(Required)

LHS website

Recruiting website (i.e. Indeed)

Friend/family

Social media

Walk-in

Other

Are you interested in:(Required)

Full Time (FT) Only

Part Time (PT) Only

FT but would consider PT

PT but would consider FT

List the hours you are UNABLE to work(Required)

Please tell us what hours you are UNAVAILABLE for work each day of the week.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Education

School(Required)

Enter the below information for each high school, college, and/or trade/business/correspondence school attended. Click the + symbol to add a new school.

School Level

Name and Location of School

Number of Years Attended

Did you graduate?

Subjects Studied

Subjects of Special Study or Research Work(Required)

Special Training/Skills/Certifications(Required)

Previous Employment

Your Previous Employers

List below the last three employers, starting with the most recent. Click the + icon to add employers.

Employer

Dates Employed

Position

Phone

Start and End Weekly Salary

Supervisor Name & Title

May we contact your supervisor? (y/n)

Description of Work

Reason for Leaving

References(Required)

Below, give the names of three persons you are not related to, whom you have known at least one year. Click the + symbol to add new references.

Name

Business

Phone Number

Ok to Text? Y/N

Email Address

Service Record

Branch of Service

Discharge Date

Have you ever been convicted of a felony?(Required)

If yes, please explain. (A felony conviction will not necessarily exclude you from consideration)

Yes

If yes, please explain:(Required)

Authorization(Required)

I certify that the facts contained in the application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contract to the foregoing, unless it is in writing and signed by an authorized company representative.

I agree to the terms and conditions.

Lexington Humane Society

ABOUT US

Get Involved

Ways to give

Programs

Services