Wild Bird House
Application for Employment

Please fill out and return in person to:
   Wild Bird House
   2900 A SW Oakley Ave
   Topeka, KS 66614
Contact Information
Name:Date:
Address:City:State:Zip:
Home Phone:Work Phone:Other Phone:Soc Sec Num:
On what date would you be available for work?Desired Hourly Wage $

Please list any times you would be un available to work:



Is there any limitation that would prevent you from lifting 50 lb bags of seed? [   ] Yes [   ] No If yes, please describe:



Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction? [   ] Yes [   ] No
Have you ever been convicted of a felony? [ ] Yes [ ] No If yes, please describe circumstances:



Have you ever been involuntarily terminated or asked to resign from any position of employment? [   ] Yes [   ] No If yes, please describe circumstances:



If selected for employment, are you willing to submit to a pre-employment drug screening test? [   ] Yes [   ] No

Employment History (most recent first)
1. Employer:Job Title:
Employment dates...From:To:Position:
Address:City:State:Zip:
Phone:Job Title:Supervisor:
Starting WageEnding Wage:
Duties Performed:

Reason for Leaving



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2. Employer:Job Title:
Employment dates...From:To:Position:
Address:City:State:Zip:
Phone:Job Title:Supervisor:
Starting WageEnding Wage:
Duties Performed:

Reason for Leaving


3. Employer:Job Title:
Employment dates...From:To:Position:
Address:City:State:Zip:
Phone:Job Title:Supervisor:
Starting WageEnding Wage:
Duties Performed:

Reason for Leaving


Education
SchoolLocationDates AttendedDegree ReceivedMajor
 




 


 


 


 


 




 


 


 


 


 




 


 


 


 



ACKNOWLEDGMENT AND AUTHORIZATION
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days.

Signature: _________________________________________________________