Fillable Printable Petco Application Form

Petco Application Form

EMPLOYMENT APPLICATION

PETCO IS AN EQUAL OPPORTUNITY EMPLOYER

01/19/2015 Page 1 of 5 application also for use by Unleashed and Pooch

PERSONAL INFORMATION

NAME (LAST, FIRST, MIDDLE)

SOCIAL SECURITY NUMBER

PHONE NUMBER

( )

STREET ADDRESS

CITY

STATE

ZIP

REFERRED TO PETCO BY:

EMERGENCY CONTACT: Name, Address, and Phone Number (including area code)

EMPLOYMENT MAY BE CONTINGENT UPON SATISFACTORILY PASSING A JOB-RELATED BACKGROUND

CHECK(S) AND/OR DRUG/ALCOHOL SCREENING.

BEFORE ANSWERING THE QUESTION BELOW, PLEASE READ THE INSTRUCTIONS IF YOU RESIDE IN, OR ARE APPLYING FOR A

POSITION IN, CALIFORNIA, CONNECTICUT, DISTRICT OF COLUMBIA, GEORGIA, HAWAII, ILLINOIS, MASSACHUSETTS, MARYLAND,

MICHIGAN, MINNESOTA, MISSOURI, NEBRASKA, NEVADA, NEWARK (NJ), NEW YORK, OHIO, PENNSYLVANIA OR WASHINGTON.

** BALTIMORE (MD), BUFFALO (NY), COLUMBIA CITY (MO), DISTRICT OF COLUMBIA, HAWAII, ILLINOIS,

MASSACHUSETTS, MINNESOTA, NEWARK (NJ), MONTGOMERY COUNTY (MD), PHILADELPHIA (PA), PRINCE

GEORGE COUNTY (MD), RHODE ISLAND, ROCHESTER (NY), SAN FRANCISCO (CA), AND SEATTLE (WA)

APPLICANTS: DO NOT ANSWER THE QUESTION BELOW AT THIS TIME.

PLEASE NOTE THAT, FOR ALL STATES, YOU DO NOT HAVE TO IDENTIFY A RECORD OF ANY ADULT OR JUVENILE ARREST,

DETENTION OR CONVICTION THAT HAS BEEN SEALED, EXPUNGED, ANNULLED, ERASED, PARDONED OR STATUTORILY

ERADICATED, SET ASIDE OR OTHERWISE DISMISSED BY COURT ORDER.

PLEASE NOTE THAT ANSWERING “YES” TO THIS QUESTION WILL NOT AUTOMATICALLY BAR YOU FROM EMPLOYMENT. ONLY

THOSE CRIMES WHICH ARE SUBSTANTIALLY RELATED TO THE POSITION YOU ARE SEEKING WILL BE CONSIDERED.

STATE SPECIFIC INSTRUCTIONS

CALIFORNIA APPLICANTS: Do not identify any misdemeanor conviction for which probation has been successfully completed or

otherwise discharged and the case has been dismissed by a court. Also, do not identify marijuana-related convictions entered by

the court more than two (2) years ago that involve: unlawful possession of marijuana; transportation or giving away of up to 28.5

grams of marijuana, other than concentrated cannabis, or the offering to transport or give away up to 28.5 grams of marijuana, other

than concentrated cannabis; possession of paraphernalia used to smoke marijuana; being in a place with knowledge that marijuana

was being used; or being under the influence of marijuana. Also, do not identify any arrest or detention that did not result in a

conviction or any record of a referral to, and participation in, any pretrial or post trial diversion program. San Francisco, California

Applicants: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will

be asked to answer criminal questions at a later point in the hiring process. At that time you will not have to identify any information

precluded by California state law or any other information relating to: (1) a conviction that has been judicially dismissed, expunged,

voided, invalidated, or otherwise rendered inoperative (for example, under California Penal Code sections 1203.1, 1203.4a, or

1203.41); (2) a conviction or any other determination or adjudication in the juvenile justice system, or a matter considered in or

processed through juvenille justice system; (3) a conviction for which more than seven years has passed since the date of

sentencing; or (4) an offense other than a felony or misdemeanor, such as an infraction.

CONNECTICUT APPLICANTS: Do not identify any arrest, criminal charge or conviction the records of which have been erased by a court

based on sections 46b-146, 54-76o or 54-142a of the Connecticut General Statutes. Criminal records subject to erasure under

these sections are records concerning a finding of delinquency or the fact that a child was a member of a family with service needs,

an adjudication as a youthful offender, a criminal charge that has been dismissed or not prosecuted, a criminal charge for which the

person was found not guilty, or a conviction for which the offender received an absolute pardon. Any person whose criminal records

have been judicially erased under one or more of these sections is deemed to have never been arrested within the meaning of the

law as it applies to the particular proceedings that have been erased, and may so swear under oath.

DISTRICT OF COLUMBIA APPLICANTS: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT

THIS TIME. You will only have to answer these questions if you receive a conditional offer of employment. At that time, you will not

have to identify any arrest or criminal accusation that is not pending against you or did not result in a conviction.

GEORGIA APPLICANTS: Do not identify any verdict or plea of guilty or nolo contendere that was discharged by a court under Georgia’s

First Offender Act.

HAWAII APPLICANTS: DO NOT ANSWER THIS QUESTION AT THIS TIME. You will only have to answer this question if you receive a

conditional offer of employment. At that time you will not be asked to identify any conviction that was entered by the court more

than ten (10) years ago, unless some period of incarceration resulting from that conviction took place within the last ten (10) years.

ILLINOIS APPLICANTS: DO NOT ANSWER THE CRIMINAL HISTORY QUESTIONS AT THIS TIME. You will only have to answer

these questions if the Company determines that you are qualified for the position for which you are applying and notifies you that

you have been selected for an interview, or if you are extended a conditional offer of employment.

EMPLOYMENT APPLICATION

PETCO IS AN EQUAL OPPORTUNITY EMPLOYER

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MARYLAND APPLICANTS: BALTIMORE, MARYLAND APPLICANTS: DO NOT ANSWER THE CRIMINAL HISTORY QUESTIONS AT THIS

TIME. You will only have to answer these questions if you receive a conditioinal offer of employment. Montgomery County and

Prince George’s County, Maryland Applicants: DO NOT RESPOND TO QUESTIONS SEEKING CRIMINAL RECORD

INFORMATION AT THIS TIME. You will only have to answer criminal history questions after an initial job interview or if you receive

a conditional offer of employment.

MASSACHUSETTS APPLICANTS: DO NOT RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION. You will be asked to answer

criminal history questions at a later point in the hiring process. At that time you will not have to identify any record relating to prior

arrests, criminal court appearances or convictions for which the record has been sealed and is on file with the Commissioner of

Probation. You also will not have to identify prior arrests, court appearances and adjudications in cases of delinquency or as a child

in need of services which did not result in a complaint transferred to the superior court for criminal prosecution. You also will not

have to identify (1) an arrest, detention or disposition regarding any violation of law in which no conviction resulted; (2) first-time

misdemeanor convictions for drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace; and

(3) convictions for other misdemeanors where the date of conviction or the end of any period of incarceration was more than five (5)

years ago, unless there have been subsequent convictions within those five (5) years.

MICHIGAN APPLICANTS: Do not identify any misdemeanor arrests, detentions or dispositions that did not result in conviction.

MINNESOTA APPLICANTS: DO NOT ANSWER THIS QUESTION AT THIS TIME. you will only have to answer this question if you are selected for

an interview or, if you are not selected for an interview, after you receive a conditional offer of employment.

MISSOURI APPLICANTS: COLUBMIA CITY, MISSOURI APPLICANTS DO NOT RESPOND TO QUESTIONS SEEKING CRIMINAL RECORD

INFORMATION AT THIS TIME. You will only have to answer this question if you receive a conditional offer of employment.

NEBRASKA APPLICANTS: Do not identify a sealed juvenile record of arrest, custody, complaint, disposition, diversion, adjudication or

sentence.

NEVADA APPLICANTS: You must identify all felony convictions, but may limit disclosure of misdemeanor convictions to those that

occurred within the last seven (7) years and which resulted in imprisonment. The discharge and dismissal of certain first time drug

offenses, after the accused has completed probation and any required treatment or educational programs, does not constitute a

“conviction” for purposes of employment.

NEW JERSEY APPLICANTS (NEWARK applicants, see further below): DO NOT RESPOND TO THE QUESTIONS SEEKING

CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions after the initial

application process, including any interview, has concluded. NEWARK, NEW JERSEY APPLICANTS: DO NOT RESPOND TO THE

QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer questions if you

receive a conditional offer of employment. At that time you will be asked whether you have any convictions for murder, voluntary

manslaughter and/or sexual offenses requiring registry under N.J. S.A. Title 2C Chapter 7 that are punishable by a term of

incarceration in state prison, regardless of the time that has passed since the conviction. You will also be asked to report any

conviction for a disorderly person offense or municipal ordinance violation (within five (5) years of sentencing) or any conviction for

any other indictable offense (within eight (8) years of sentencing). If your criminal history includes a reportable conviction for a

disorderly person or other indictable offense, you may be asked to report additional non-expunged convictions as allowed by law.

NEW YORK APPLICANTS: Do not identify records concerning any criminal proceeding that terminated in your favor, per section 160.50

of the New York Criminal Procedure Law; any criminal proceeding that terminated in a “youthful offender adjudication,” as defined in

section 720.35 of the New York Criminal Procedure Law; any conviction for a “violation” that already has been sealed by the court,

per section 160.55 of the New York Criminal Procedure Law; and any conviction which was sealed pursuant to section 160.58 of the

New York Criminal Procedure Law. BUFFALO, NEW YORK APPLICANTS: DO NOT ANSWER THIS QUESTION AT THIS TIME. You will ony have to

answer this question if you receive a job interview or a conditional offer of employment. ROCHESTER, NEW YORK APPLICANTS: DO NOT

RESPOND TO THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer

criminal history questions after you submit an application and complete an initial interview.

OHIO APPLICATIONS: DO NOT IDENTIFY ANY ARREST OR CONVICTION FOR A MINOR MISDEMEANOR DRUG VIOLATION AS DEFINED UNDER OHIO REV.

CODE 2925.11.

PENNSYLVANIA APPLICANTS: Do not identify convictions for summary offenses. PHILADELPHIA, PA APPLICANTS: DO NOT ANSWER THIS

QUESTION AT THIS TIME. You will only have to answer this question if you receive a conditional offer of employment.

RHODE ISLAND APPLICANTS: DO NOT ANSWER THIS QUESTION AT THIS TIME. You will ony have to answer this question if you receive a job

interview or a conditional offer of employment.

WASHINGTON APPLICANTS: Do not identify any arrests or criminal charges that did not result in conviction. Also, do not identify any

conviction that was entered by the court more than ten (10) years ago, unless some period of incarceration resulting from that

conviction took place within the last ten (10) years. SEATTLE, WA APPLICANTS: DO NOT ANSWER THIS QUESTION AT THIS TIME. You will

only have to answer this question after completing an initial screen.

EMPLOYMENT APPLICATION

PETCO IS AN EQUAL OPPORTUNITY EMPLOYER

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HAVE YOU EVER BEEN CONVICTED OF OR PLEAD GUILTY TO ANY CRIMINAL CHARGE(S)? (NOTE: This includes misdemeanor(s) and/or felony(s) that are driving related)

YES NO

(1) CHARGE NAME: ____________________________________________________________________________________________________________________________________

MISDEMEANOR FELONY

YEAR: _______________ COUNTY:______________________________ STATE: ____________________

(2) CHARGE NAME: ____________________________________________________________________________________________________________________________________

MISDEMEANOR FELONY

YEAR: _______________ COUNTY:______________________________ STATE: ____________________

(3) LIST ANY ADDITIONAL CHARGES HERE:

_________________________________________________________________________________________________________________________________________________

ARE YOU CURRENTLY AWAITING TRIAL OR HAVE ANY ACTIVE PENDING CRIMINAL OFFENSE(S)?

(NOTE: This includes misdemeanor(s) and/or felony(s) that are driving related)

YES NO

PLEASE EXPLAIN ANY “YES” ANSWER BELOW:

__________________________________________________________________________________________________________________________________________________

WORK CONDITIONS

POSITION FOR WHICH YOU ARE APPLYING:

SALARY EXPECTATIONS:

DATE AVAILABLE FOR WORK:

FULL-TIME

PART-TIME

WITH REGARD TO INITIAL WORK LOCATION, DO YOU HAVE ANY GEOGRAPHIC PREFERENCES? YES NO

IF YES, SPECIFY:

ARE YOU WILLING TO TRAVEL? YES NO

IF YES, WHAT PERCENTAGE? ________%

STORE MANAGEMENT POSITIONS MAY REQUIRE USE OF A CAR OR OTHER MOTORIZED VEHICLE. IF USE OF SUCH A VEHICLE WERE REQUIRED IN THE JOB FOR

WHICH YOU ARE APPLYING:

A. DO YOU HAVE OR CAN YOU GET A VALID DRIVER’S LICENSE?

YES NO

B. DO YOU HAVE ACCESS TO A CAR OR OTHER MOTORIZED VEHICLE?

YES NO

C. DO YOU HAVE OR CAN YOU OBTAIN INSURANCE COVERAGE ON SUCH A VEHICLE?

YES NO

PLEASE INDICATE YOUR AVAILABILITY. PETCO MAY ATTEMPT TO

ACCOMMODATE YOUR AVAILABILITY PREFERENCES, HOWEVER BUSINESS

NEEDS WILL DETERMINE WORK SCHEDULES.

MON

TUES

WED

THUR

FRI

SAT

SUN

COMPANY QUESTIONS

CAN YOU PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING WITH OR WITHOUT REASONABLE

ACCOMMODATION?

YES NO

IF NO, DESCRIBE THE FUNCTIONS THAT CANNOT BE PERFORMED:

NOTE: WE COMPLY WITH THE ADA AND WILL CONSIDER REASONABLE ACCOMMODATION MEASURES THAT MAY BE NECESSARY FOR ELIGIBLE

APPLICANTS/ASSOCIATES TO PERFORM ESSENTIAL JOB FUNCTIONS.

ARE YOU LEGALLY AUTHORIZED TO WORK IN THE UNITED STATES? YES NO, AND

WILL YOU NOW OR IN THE FUTURE REQUIRE SPONSORSHIP FOR EMPLOYMENT VISA STATUS (E.G., H-1B VISA STATUS)? YES NO

HAVE YOU EVER WORKED OR APPLIED FOR WORK WITH PETCO?

YES NO

IF YES, WHERE AND WHEN?

DATE OF FIRST EMPLOYMENT:

ARE YOU 18 YEARS OF AGE OR MORE?

YES NO

EMPLOYMENT APPLICATION

PETCO IS AN EQUAL OPPORTUNITY EMPLOYER

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WORK EXPERIENCE

Please list ALL jobs, beginning with your present or most recent employer. Account for ALL time periods, including UNEMPLOYMENT, SELF-EMPLOYMENT, and U.S.

MILITARY SERVICE. If space is limited, list on a separate page or additional application form. (Please ensure your name is on the separate paper.) Use of “see resume” is

unacceptable.

START DATE

END DATE

STARTING SALARY (REQUIRED)

ENDING SALARY (REQUIRED)

COMPANY NAME AND ADDRESS

TELEPHONE NUMBER

( ) -

MAY WE CONTACT EMPLOYER?

YES NO

TYPE OF BUSINESS

JOB TITLE

DEPARTMENT

SUPERVISOR

DUTIES AND RESPONSIBILITIES

REASON FOR LEAVING:

START DATE

END DATE

STARTING SALARY (REQUIRED)

ENDING SALARY (REQUIRED)

COMPANY NAME AND ADDRESS

TELEPHONE NUMBER

( ) -

MAY WE CONTACT EMPLOYER?

YES NO

TYPE OF BUSINESS

JOB TITLE

DEPARTMENT

SUPERVISOR

DUTIES AND RESPONSIBILITIES

REASON FOR LEAVING:

START DATE

END DATE

STARTING SALARY (REQUIRED)

ENDING SALARY (REQUIRED)

COMPANY NAME AND ADDRESS

TELEPHONE NUMBER

( ) -

MAY WE CONTACT EMPLOYER?

YES NO

TYPE OF BUSINESS

JOB TITLE

DEPARTMENT

SUPERVISOR

DUTIES AND RESPONSIBILITIES

REASON FOR LEAVING:

START DATE

END DATE

STARTING SALARY (REQUIRED)

ENDING SALARY (REQUIRED)

COMPANY NAME AND ADDRESS

TELEPHONE NUMBER

( ) -

MAY WE CONTACT EMPLOYER?

YES NO

TYPE OF BUSINESS

JOB TITLE

DEPARTMENT

SUPERVISOR

DUTIES AND RESPONSIBILITIES

REASON FOR LEAVING:

EDUCATION & CERTIFICATIONS

List the education experiences below, starting with the most relevant education.

SCHOOL NAME & ADDRESS (INCLUDE CITY & STATE)

LAST GRADE

OR LEVEL

COMPLETED

DECLARE THE DEGREES /

CERTIFICATIONS RECEIVED

COURSE

OR MAJOR

HIGH SCHOOL

COLLEGE

PHD

OTHER ________

CERTIFICATIONS

EMPLOYMENT APPLICATION

PETCO IS AN EQUAL OPPORTUNITY EMPLOYER

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REFERENCES

(Please indicate at least one)

NAME

ADDRESS

PHONE NO.

RELATIONSHIP TO YOU (PROFESSIONAL / PERSONAL)

( ) -

All Petco Locations Are Designated As Non-Smoking

Please Read Carefully And Sign Below:

I certify that all of the information furnished on this application and during the application process is true, complete and

correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in

refusal to hire, or if hired, may result in my dismissal at any time regardless of when the false answer or omissions are

discovered.

I recognize that this employment application is not an offer of employment. I agree that if I am hired by Petco, I will be an

at-will employee, meaning that either Petco or I may end the employment relationship at any time with or without cause or

notice. I understand that only Chief Executive Officer of Petco, and no manager, supervisor, or representative of Petco,

has authority to enter into any agreement for any specified period of time, or to make any arrangement contrary to the at-

will employment relationship, and with respect to the Chief Executive Officer, any such agreements must be in writing and

is subject to approval by Petco’s Board of Directors.

I further understand and agree that, except for employment at-will status, if hired my wages, hours, working conditions, job

assignment(s), and compensation rate(s) will be subject to change by Petco.

I understand that Petco may share the information contained in this application with other Petco employees for

employment and administrative purposes and herby consent to such transfer.

I hereby authorize Petco to conduct any necessary investigation regarding my background as it relates to the position I am

seeking and to the extent permitted by federal, state, and local law. I agree to complete the requisite authorization forms

for the background investigation. I hereby release all parties from any liability in connection with the provision and use of

such information.

I agree to submit to legally permissible drug testing upon an offer of employment from Petco and prior to starting work. I

agree that any offer of employment is contingent upon my receiving a negative test result.

I understand and expressly agree that if employed by Petco, storage areas provided for me (locker, desk etc.) are open to

investigation by the Company without prior notice to me.

If hired, I agree to abide by all of Petco’s Code of Ethics, policies and procedures.

Massachusetts Applicants: I understand that is unlawful in Massachusetts to require or administer a lie detector test as a

condition of employment or continued employment. An employer who violates this law shall be subject to criminal

penalties and civil liability.

Maryland Applicants: I understand that under Maryland law, an employer may not require or demand as a condition of

employment, prospective employment or continued employment, that any individual submit to or take a lie detector or

similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100.

My signature below certifies that I agree to be bound by the terms and conditions stated in this application, which contains

all the understandings between Petco and me concerning the topics addressed herein, and supersedes any prior

inconsistent understandings between Petco and me on such issues.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENTS.

BY MY SIGNATURE BELOW, I CERTIFY I HAVE READ, FULLY UNDERSTAND AND ACCEPT ALL TERMS OF THE FOREGOING STATEMENT.

APPLICANT’S SIGNATURE:

DATE: