Name_________________________________________________________________________

Social Security #______________________________ Date of Birth:______________________

Address________________________________________________________________________

Phone Number(s)_________________________________________________________________

Have you ever been convicted in any court of any offense, including traffic violations?__________

If yes, please give details:___________________________________________________________

(Conviction is not an automatic bar to employment)

Are you a US citizen?_____________________

What is the present condition of your health?____________________________________________

How much time have you lost due to illness in the last 2 years?______________________________

Hobbies or special interests:__________________________________________________________

Do you presently own any pets of your own?_____________________________________________

If so, what kind, and how long owned?__________________________________________________

Do you have a valid driver's license?____________Do you have your own transportation?________

What company do you have auto insurance with?_________________________________________

Please check which rounds you are available to make:

Morning (7:30-10:30 am)___________________Mid-day (10:00 am-4:00 pm)_______________

Evening (4:30-8:00 pm)____________________ Weekends______________________________

Are there any pets you would refuse to care for?___________________________________________

In your own words, why would you like to be a Bone Voyage pet sitter?

Date available for work?_____________________________

WORK EXPERIENCE:  Start with your most recent employer and work back.

1.  Place of employment:________________________Position:_______________________________

Dates there:_________________________Immediate Supv:___________________________

Reason for leaving:___________________Last Salary:____________________________

2.  Place of employment:_________________________Position:______________________________

Dates there:__________________________Immediate Supv:__________________________

Reason for leaving:____________________Last Salary:___________________________

3.  Place of employment:_________________________Position:______________________________

Dates there:__________________________Last Salary:___________________________

May we contact these employers regarding your character and record of employment?__________

Please provide four references (not relatives) that we may contact who have known you for several years and can attest to your good character.

________________________________________________________________________________

NamePhone NumberYears Known

_______________________________________________________________________________

NamePhone NumberYears Known

_______________________________________________________________________________

NamePhone NumberYears Known

________________________________________________________________________________

NamePhone NumberYears Known

EDUCATION:

High school:______________________________________ From:__________  To:__________

Business School:___________________________________ From:__________ To:__________

Trade/Tech school or college_________________________ From:__________ To:__________

College:__________________________________________ Major/degree_________________

Please read carefully:

I certify that all of the statements made in this application are true and correct to the best of my knowledge and belief and are made in good faith.  I give Bone Voyage, Inc. and its agents the right to investigate all information given and to secure additional information, if necessary.  I hereby release from all liability or responsibility all persons, corporations furnishing such information.

I further understand that the completion of this application does not assure me of employment and does not obligate Bone Voyage, Inc. to me in any way.

I further understand that this application will be retained for active employment consideration for six months following the date of submission.  To remain in consideration for employment after that time, it will be necessary that I complete another application.

I further understand that any misleading or incorrect statement or failure to complete any part of this application not prohibited by law may render this application void and if employed would be cause for immediate discharge.

Finally, I understand that in the event that I am selected to work for Bone Voyage, Inc., it will be in the capacity of an Independent Contractor only and that there will be no benefits paid.  It will be my responsibility to pay estimated taxes to avoid any IRS penalties. 

___________________________________________________

Signature