Job application form
Thank you for your interest in working at the Lynchburg Humane Society. All applications are screened for open positions and the best-qualified applicants are scheduled for an interview.
Email address *
Name *
First and last name
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Address (street, city, state, zip code) *
Your answer
Phone number *
Your answer
Which location are you applying to? *
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Which position(s) are you applying for? (for a list of openings click here - goo.gl/Qpvfnc) *
Your answer
Desired rate of pay: *
Your answer
Date available to start: *
MM
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Are you applying for a full time or part time position? *
What days are you available to work? Please check all that apply *
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Time availability - Please check all that apply *
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Recent work history (list your three most recent employers; start with the most recent first):
Employer 1:
Employer Name:
Your answer
Phone:
Your answer
Address, city, state:
Your answer
Type of business:
Your answer
Duties (briefly describe):
Your answer
Wages
Your answer
Start Date:
MM
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DD
/
YYYY
End Date:
MM
/
DD
/
YYYY
Reason for Leaving
Your answer
Employer 2:
Employer Name:
Your answer
Phone:
Your answer
Address, city, state:
Your answer
Type of business:
Your answer
Duties (briefly describe):
Your answer
Wages
Your answer
Start Date:
MM
/
DD
/
YYYY
End Date:
MM
/
DD
/
YYYY
Reason for Leaving
Your answer
Employer 3:
Employer Name:
Your answer
Phone:
Your answer
Address, city, state:
Your answer
Type of business:
Your answer
Duties (briefly describe):
Your answer
Wages
Your answer
Start Date:
MM
/
DD
/
YYYY
End Date:
MM
/
DD
/
YYYY
Reason for Leaving
Your answer
Describe any additional work and other experiences you feel are applicable; include any other skills, knowledge, or abilities you would like us to consider (please include your computer/other machine skills and languages spoken besides English)
Your answer
Education History
High School
Your answer
Did you graduate? *
College Name
Your answer
Did you graduate
Dates Attended:
Your answer
Focus of Study
Your answer
Other School Name
Your answer
Did you graduate?
Dates Attended
Your answer
Focus of Study
Your answer
Why would you like to work for the Lynchburg Humane Society?
Your answer
Describe your experience with animals. Be sure to include types (dogs, cats, birds, etc.) and any special training and/or skills:
Your answer
Have you ever been employed by LHS before? *
If yes, when?
Your answer
Have you ever been interviewed by LHS before? *
If yes, when?
Your answer
Have you been convicted of a felony within the last seven (7) years? *
Have you ever been convicted of animal cruelty, neglect, or abandonment? *
Enough of that serious (but important) stuff, it's time to have some and be honest
What do you enjoy about the workplace. What annoys you in the workplace? *
Your answer
What three things would you bring to a deserted island? *
Your answer
If you could meet anyone living or dead who would you meet? *
Your answer
How lucky are you and why? *
Your answer
What sound do you love? *
Your answer
What is the coolest thing you have been for Halloween? *
Your answer
A penguin walks through that door right now wearing a sombrero. What does he say and why is he here? *
Your answer
If you could live in one TV Show or Movie for one week as a character which would you choose? *
Your answer
On a scale of 1-10 how narcissistic are you? *
A little
A lot
The LHS is committed to affording all qualified individuals an equal opportunity to pursue employment and advancement. We do not discriminate against any person or group based on ethnicity, race, color, creed, religion, sex/gender, sexual orientation, disability,veteran status, marital status, or any other legally protected status.The LHS will afford reasonable accommodation to qualified applicants and staff with a known disability or for a staff member’s religious beliefs, unless to provide such accommodation creates undue hardship on the business operations.
In submitting this application for employment, I understand and agree with the following checked items: *
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Please note, we are not able to acknowledge receipt of every application. Only applicants who we wish to interview will be contacted.
By typing your name below serves as your signature: *
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