PERSONAL INFORMATION

Last Name:                                                       First Name:                                                    Middle Name:

Street Address:

City/Town:                                                      State:                         Zip:

Home Phone:                                                   Cell Phone:

EMPLOYMENT INFORMATION

Position applied for:                                               Rate of pay expected:

                           $ per hour

Have you previously applied here?                                    If yes, when?

NO        YES                                                                  

Were you previously employed by AMC?                         If yes, when?

NO     YES                                                                     

Referred by:                                                        Name of any friends/relatives employed at AMC:

EDUCATION INFORMATION

High School Name:                                                     Degree Awarded:                                   Dates Attended:

College/Business or Trade School Name:           Degree Awarded:                                    Dates Attended:

Other Name:                                                                  Degree Awarded:                                    Dates Attended:

WORK HISTORY (Begin with most recent)

1.  Name of Company:                                          Business Address:                       

City:                                                State:                Zip:                                            Phone:

Type of Business:                                Immediate Supervisor:              Dates Of Employ:                    Reason for Termination:

Duties:

2.  Name of Company:                                          Business Address:                       

City:                                                State:                Zip:                                            Phone:

Type of Business:                                Immediate Supervisor:              Dates Of Employ:                    Reason for Termination:

Duties:

3.  Name of Company:                                          Business Address:                       

City:                                                State:                Zip:                                            Phone:

Type of Business:                                Immediate Supervisor:              Dates Of Employ:                    Reason for Termination:

Duties:

Do you have any other experience with animals that you think we should consider?

I certify that the information I have provided in this application is true.  I understand that false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.  I understand and accept that AMC may request an investigative consumer report from an agency.  I understand and accept that AMC is an Alabama Drug-Free Workplace and that all new employees are required to undergo Substance Abuse Testing.  I understand that this application does not create a contract of employment.  If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause, and with or without notice.  I have read, understand, and by my signature consent to these statements.

Signature (Typing in your full name acts as your signature):

The date and time of submission and your computer's IP address will be recorded when you click Submit.