Please Read Carefully And Complete By Printing In Ink Or Typing.

We are an equal opportunity employer, and we do not and will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose.

Provide All Information Requested. Your complete application form will be maintained in our active files for six (6) months from the date of application. You may submit a new application at any time.

Personal Information

Last Name: ________________________ First: _________________ MI: ____

Social Security Number: ______________ Date of Application: _____________

Street Address: ___________________________________________________

City: ___________________ State: _________ Zip: ____________

Home Telephone: ________________ Work Telephone: _________________

Are you at least 18 years of age? ____ Are you legally eligible for employment in the U.S.? ____

Have you been convicted of a felony in the past 7 years? ________________________________

Type(s) of Work Desired:

Full Time: ____ Availability: Sun. Mon. Tue. Wed. Thu. Fri. Sat.

Part Time: ____ ___ ___ ___ ___ ___ ___ ___

Wage or Salary Expected: ______________ Are you able to work overtime? _________

Date Available: _________________

Educational History

High School:

School Name: _____________________________________________

Location (city, state): __________________________________

Dates Attended: From _____________ To _______________

Graduated: Yes ____ No ____

College/Other (Post High School)

School Name: _____________________________________________

Location (city, state): ___________________________________

Major Course or Subject:________________________________

Dates Attended: From _____________ To _______________

Graduated: Yes ____ No ____

Degree: __________________

College/Other (Please list all attended)

School Name: _____________________________________________

Location (city, state): __________________________________

Major Course or Subject: _______________________________

Dates Attended: From _____________ To _______________

Graduated: Yes ____ No ____

Degree: __________________

Additional Job-Related Seminars, Workshops, or Other Educational Experiences

Please List: ___________________________________________________________________

_____________________________________________________________________________

Please use additional sheets for continuation of educational history, if applicable.

Employment History

Starting with present or most recent, list all previous employers. Please include self-employment as well as summer and part-time jobs. If more space is required, please continue on a separate sheet. You may attach a resume, but complete this application as well.

1. Last or Present Company: ___________________________________________________

Type of Business: ______________________________________________________________

Type or Classification of Job: _____________________________________________________

City: _________________ State: ______ Phone Number: _______________

Brief Description of Job Duties: ____________________________________________________

_____________________________________________________________________________

Supervisor's Name: ________________ Base Salary: ______ Dates Worked: From____ To____

Reason for Leaving: _____________________________________________________________

Is there a reason why you would not want us to contact this employer? _____________________

2. Previous Employer: _________________________________________________________

Type of Business: ______________________________________________________________

Type or Classification of Job: _____________________________________________________

City: _________________ State: ______ Phone Number: _______________

Brief Description of Job Duties: ____________________________________________________

_____________________________________________________________________________

Supervisor's Name: ________________ Base Salary: ______ Dates Worked: From____ To____

Reason for Leaving: _____________________________________________________________

Is there a reason why you would not want us to contact this employer? _____________________

3. Previous Employer: _________________________________________________________

Type of Business: ______________________________________________________________

Type or Classification of Job: _____________________________________________________

City: _________________ State: ______ Phone Number: _______________

Brief Description of Job Duties: ____________________________________________________

Supervisor's Name: ________________ Base Salary: ______ Dates Worked: From____ To____

Reason for Leaving: _____________________________________________________________

Is there a reason why you would not want us to contact this employer? _____________________

Please use additional sheets for continuation of employment history, if applicable.

Professional/Work References

List three references that are not relatives whom you have known for at least one year.

1. Name: __________________________ 2. Name: __________________________

Title/Relationship: ___________________ Title/Relationship: ___________________

Phone Number: ____________________ Phone Number: ____________________

3. Name: __________________________

Title/Relationship: ___________________

Phone number: _____________________

Emergency Contact Information

Name: _______________________ Address:______________________________________

City: __________________ State: ___ ZIP: ________ Daytime Phone Number: _____________

Relationship: _________________________

Questions and Special Skills

Are you a pet owner? ______ If yes, please elaborate: __________________________________

_____________________________________________________________________________

Please list any skills relevant to the position applied for: _________________________________

_____________________________________________________________________________

Describe a situation where you provided excellent customer service: _______________________

_____________________________________________________________________________

_____________________________________________________________________________

What would make you a great fit for the Muttropolis Team? ______________________________

_____________________________________________________________________________

Agreement

I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company's service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment.

If hired, your employment with Muttropolis, LLC (“Company”) is “at will” in that your employment by the Company will be completely in the discretion of, and at the will of, the Company and yourself, and can be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or yourself.

No supervisor, manager or representative of the Company other than Janet McCulley or Steve Goldberg, Manager and President of Muttropolis LLC has any authority to enter into any agreement for employment for any specified period of time or to make any agreement or modification to the foregoing. Any offer of employment or any promises to the contrary may only be relied upon by you if they are in writing and signed by Janet McCulley or Steve Goldberg, Manager and President.

Agreed:

___________________________________________________ Date: ______________

Signature

___________________________________________________

Print Name

NOTE: If any of your educational or employment records are under other than the above name, please provide other names.

____________________________________________________