Name *

First Name

Last Name

Cell Number *

(###)

###

####

Are you over 18 years old?

Yes

No

Reference 1 *

First Name

Last Name

Phone *

(###)

###

####

Reference 2

First Name

Last Name

Phone

(###)

###

####

Supervisor *

First Name

Last Name

Phone *

(###)

###

####

Supervisor

First Name

Last Name

Phone

(###)

###

####

Graduated

Yes

No

Graduated

Yes

No

Are you allergic to any animals?

Yes

No

Are you able to stay in a client's home overnight?

Yes

No

Are you available to work a consistent M-F schedule?

Yes

No

Please mark all times you're available to care for pets

7am - 9am

10am - 3pm

4pm - 6pm

7pm - 9pm

Are you available to work weekends if needed?

Yes

No

Can you lift 50+ pounds?

Yes

No

Are you willing to transport dogs in your car?

Yes

No

Have you ever been convicted of a crime?

Yes

No