Print this application, complete it and mail the completed form to:
Animal Friends of Barbour County
c/o Kimberly J. Delauder
2431 Morgantown Pike
Belington  WV  26250

   It is our policy to provide equal employment opportunity to all qualified persons without regard
   to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental handicap,
   or veteran status.


Name:  Last                                              First                                            Middle 

Street Address

City                                                                          State                                   Zip

Telephone (Home)                                                     (Cell)

Social Security #                                                        WV Driver's License # 

Position applied for 

How did you hear of this opening?  

When can you start?  

Are you a U.S. citizen or otherwise authorized to work in the U.S. on unrestricted basis?     Yes       No

Do you understand that this is a part time position?         Yes           No

Are you available to work in the evenings?                       Yes           No
Have you ever been convicted of a felony?                       Yes           No
If yes, please fully describe the circumstances: 

Education:    School Name                                 Location                                         Year Graduated

High School



   In addition to your work history, are there are other skills, qualifications
   or experience we should consider: 

Employment History: (Start with most recent employer.)

Company Name 

Address                                                                                            Telephone 

Date Started                              Starting Wage                     Starting Position 

Date Ended                                Ending Wage                       Ending Position 

Name of Supervisor                                                                             May we contact:       Yes         No


Reason for leaving

​Attach additional employment information if necessary.

       I certify that the facts set forth in this application for employment are true and complete
       to the best of my knowledge. I understand that if I am employed, false statements on this
       application shall be considered sufficient cause for dismissal. Animal Friends is hereby
       authorized to make any investigations of my prior education and employment history.
       I understand that employment with Animal Friends is "at will," which means that either
       I or Animal Friends can terminate the employment relationship at any time, with
       or without prior notice, and for any reason  not prohibited by statute.

          Signature                                                                      Date 
Click "Submit" to have this emailed