Name _______________________________________

     Connie Winters’ Kennels, Inc.  is  an equal opportunity Employer and will not

discriminate on the basis of race, creed, religion, color, national origin, ancestry, age,

sex, affection or sexual orientation, martial status, atypical heredity, cellular or blood

trait, disability for service in the United States Armed Forces or any other legally

protected status.  Connie Winters’ Kennels, Inc. will make a reasonable

accommodation to known physical or mental limitations of a qualified applicant or

employee with a disability unless the accommodation would impose an undue

hardship on the operation of its business.

Must fill out all questions completely to be considered for employment

Personal Information

 Name _______________________Telephone(s)_____________________

Address_____________Town_________State__________Zipcode_______ 

Are you either 18 yrs of age or in possession of a work permit? Yes_____ No___

Are you either a U. S citizen or an alien who is authorized to work in the U. S.?

Yes______ No______

(If you answered “yes” you must complete the I-9 form required by the U.S.

 Immigration &  Naturalization Service no later than three (3) business days

after your date of hire)

 References Below give the names of three persons that you are not related to,

 whom you have known for at least one year.  Must be completely filled in.

 Background Have you ever applied for employment with this company?  ____Date_______ 

Were you ever employed by this company? __________

Dates ______to _____ Have you ever been convicted of a crime?  Yes__ No __

(A conviction will not necessarily be a bar to employment.  Please describe the

nature of the conviction, the date of the conviction and your rehabilitation

since your conviction.) ___________________________________________

 Former Employers:  (must be filled out completely)   Please list all employers. Use Extra

 sheets if necessary.  Please explain any gaps in employment. Name of present

 or last employer______________Address__________________Telephone______

Starting date______________  Leaving date_____________ Job title__________

Weekly starting salary____________ Weekly final alary__________________

May we contact your supervisor?   Yes______________  No________ 

If yes:  Name of supervisor__________________title________ Phone_______________

Description of work:  ______________________________________________________

Reason for leaving:   _______________________________________________________ 

 Name of previous employer:  ________________________________________________

 Address ________________________________________ Telephone______________

Starting date______________  Leaving date_____________ Job title_______________

Weekly starting salary____________ Weekly final salary________________________

May we contact your supervisor?   Yes___________  No________ 

If yes: Name of supervisor_______________title_______ Phone___________________

Description of work:  ______________________________________________________

Reason for leaving: _______________________________________________________  

Name of previous employer: _________________________________________________

Address___________________________________ Telephone ____________________

Starting date_______  Leaving date_______ Job title____________________________

Weekly starting salary____________ Weekly final salary________________________

May we contact your supervisor?   Yes_______ No_____________ 

 If yes: Name of supervisor:__________________title________Phone_______________

Description of work: ______________________________________________________

Reason for leaving: _______________________________________________________

Please list all other employers and the above information for each. 

Please use this space to explain other jobs, skills or interests relevant to

employment with Connie Winters’ Kennels, Inc. (use extra sheet if necessary)

Dog & cat experiences______________________________________________

Cleaning & housekeeping experiences _________________________________

Retail Sales experinces _____________________________________________

Other animal expereinces____________________________________________

Mechanical interests or skills ________________________________________

Handyman or carpentry skills__________________________________________

Beautician or grooming skills__________________________________________

Other skills or interests ______________________________________________

Other information you would like us to know about your experiences, skills or

activities,  not described above,  which you would like us to consider in evaluating

your qualifications for the position sought. (You are not required to list any

 information , which may tend to reveal a protected characteristic as set forth

 in the EEO statement above.)___________________________________________

What interests you the most about employment at Connie Winters' Kennels, Inc.

_____________________________________________________________________

Because all staff members must be able to handle all types and sizes of dogs and cats, do you

 have any physical and/ or mental limitations that would make you unable to fulfill

those job responsiblities?   Yes____________  No ___________

Do you have outside interests that would keep you from fulfilling weekend and

 holiday scheduling requirements?  Yes ____________  No ___________

How did you learn of Connie Winters' Kennels, Inc. employment opportunities?_______

What would you like to gain from your employment with Connie Winters' Kennels, Inc.?

________________________________________________________________________

What type of work environment do you function the best in:

         ___________ Told what to do and left to do the task.

         ___________ Work with a co-worker to share the job responsiblities

         ___________ Other, explain why_____________________________

What type of management do you work the best for___________________

What type of management style is difficult for you to deal with___________

What type of co-workers are easy for you to get along with ______________

What type of co-workers are difficult for you to get along with ____________

 ________________________________________________________________

A photo copy of all applicants social security and drivers license or other

photo id. will be requested to process the application upon final acceptance of

employment  Applicant acknowledges that all information listed on this application

 is true and hereby authorizes Connie Winters' Kennels, Inc. to verify information

 by obtaining, not limited  to, the following: criminal background check, consumer

 credit report, civil reports, employment verification.  I release from all liability and

 responsibility all persons and entities, requesting or supplying information about

 any information provided on this application, including my present employer. 

     I understand that if employed by Connie Winters’ Kennels, Inc. I will be

an employee at will, which means that I can voluntarily end my employment or

be terminated at any time for any reason or no reason at all.  No statement

whether written or oral, by any Company representative other than a written

 statement signed by the President may vary the foregoing.

Signature of Applicant  ______________________ Date  _______