APPLICATION FOR "Part-Time" EMPLOYMENT

INSTRUCTIONS: You must answer all of the following questions to be considered for “part-time” employment. This form was designed to ensure that it complies with all federal and state laws regarding employment. Please print your answers and be certain to accept the conditions of employment at the bottom. If you need help to complete the application, please ask our representative.

Personal Information

Name
Telephone Number
Street
City
State
Zip
Cell/Digital Phone
If younger than 21, state your age here
Have you ever been convicted of a crime?
If convicted of a crime(s), explain here:

Education

Years of Education (Select Highest Grade of School Completed)

Availability

1.
What position are you applying for?
Salary Desired
2.
How did you hear about job opening?
3.
Type of work sought (select one)
4.
When are you available to start to work?
5.
Are you available to work anytime?
If "No", list your specific hours available below:
Monday
to
Tuesday
to
Wednesday
to
Thursday
to
Friday
to
Saturday
to
Sunday
to
6.
Are you available to work throughout the calendar year?
If "No", explain
7.
Have you ever been employed by Feeders Supply?
If "Yes", provide dates & locations
8.
Which Feeders Supply store(s) are you interested in working in? (select YES to all that apply)
ALL STORES
Baxter
Middletown
Fern Creek
Preston
Hikes Point
Springhurst
Dixie
St. Matthews
Holiday Manor
Elizabethtown
Shepherdsville
Pewee Valley
Frankfort
INDIANA STORES:
New Albany
Clarksville
State Street

Experience

(List your most recent position first)
Do you have personal or professional pet experience?
1.
Employer
Address
Dates of Employment
to
Job Title
Pay
per
Supervisor
Reason you left
Please Explain Why You Left:
2.
Employer
Address
Dates of Employment
to
Job Title
Pay
per
Supervisor
Reason you left
Please Explain Why You Left:
3.
Employer
Address
Dates of Employment
to
Job Title
Pay
per
Supervisor
Reason you left
Please Explain Why You Left:

References (Please include Telephone Number)

(REQUIRED if you have No Work Experience; Do Not List Family Members)
1.
2.
3.
Briefly describe why you are applying for this position.
Please describe your strengths and talents and how our company will benefit from your work here.

Conditions of Employment - Feeders Supply Company

1.
I understand that any false statements on this application may cause my immediate dismissal.
2.
I authorize whatever background investigations and personal reports as deemed necessary to: (a) verify that the information I have supplied is true and accurate: (b) determine my fitness for this job, and: (c) hold harmless those who have the responsibility to develop such a report. A copy of this authorization is as valid as the original.
3.
I understand that Feeders Supply Company operates under specific policies and procedures. I agree to accept and comply with them.
4.
I understand that overtime work may be a condition of employment.
5.
In consideration of my employment, I agree to conform to the rules and regulations for employees. I understand:
(A.)
I am an employee at will.
(B.)
This application is not a contract of employment with Feeders Supply Company.
(C.)
My employment and compensation can be terminated, with or without cause, at any time, at the option of either Feeders Supply Company or me.
6.
That no representative of Feeders Supply Company, has any authority to enter into any verbal agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and that no document, policy or practice of Feeders Supply Company, may change the foregoing unless it is expressly titled "Employment Agreement" and signed by both myself and the President/CEO of Feeder Supply Company.
7.
I understand that I may be required to submit to lawfully authorized pre-employment and post-employment tests for fitness and/or substance abuse.
8.
Upon separation of employment, I authorize Feeders Supply Company, to withhold from my final paycheck any monies owed to them by me for equipment, loans, products, services, materials, or other assets in my possession not returned.
9.
I agree that any employment-related dispute, complaint, or conflict that cannot be resolved internally may be referred to Alternative Dispute Resolution.