Montgomery County Humane Society, Inc. (MCHS) is an equal opportunity/affirmative action employer. All qualified applicants, based upon job related qualifications, will be  considered without regard to age, race, color, sex, religion, national origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, physical or mental disability or any other classification proscribed under applicable federal, state or local law.

EMPLOYMENT HISTORY

List below your last four (4) employers, starting with the last one first. All information MUST be completed. You may attach

a resume, but it does not take the place of completing all the required information.

Employment History 1

Employment History 2

Employment History 3

Employment History 4

PROFESSIONAL REFERENCES: 

List three (3), other than relatives

Please Provide - NAME, RELATIONSHIP, PHONE NUMBER & YEARS KNOWN

ADDENDUM TO MONTGOMERY COUNTY HUMANE SOCIETY’S EMPLOYMENT  APPLICATION

I understand that the position I am applying for may/will require me to:

• Lift between 15 – 60 lbs.

• Restrain a 65 lb. animal

• Stand for long periods of time

• Pass a police background check

CERTIFICATION AND AUTHORIZATION

I certify that the facts contained in this application are true and correct. I understand that, in the event of my employment by the MCHS, I shall be subject to dismissal if any information that I have given in the  application is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. 

I understand that I shall be required to provide documentation establishing my legal authorization for employment prior to commencing work. I understand that if employed, my employment will be at will and that this is not a contract for employment or a guarantee of employment. The Employer is an Equal Opportunity Employer and shall treat all employees and applicants for employment equally and fairly based upon job related qualifications and in accordance with all applicable local, state and federal laws.

This waiver does not permit the release or use of disability-related or medical information in manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”

UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT.  ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FIND NOT TO EXCEED $100.

DO NOT WRITE BELOW THIS LINE - MCHS INTERVIEW INFORMATION

INTERVIEWED BY:

DATE OF INTERVIEW:

REMARKS: