Student Application Position applying for: Title: Pet Groomer Student (Wash-N-Wag of Culpeper) ID: SG2 Student Location: Culpeper, Virginia How did you hear of this educational opportunity? If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Source If referred, please provide name First Name: * Last Name: * Address 1: * Address 2: City: * State: * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Phone 1: * Phone 2: Email * Have you applied here before? YesNo If so when? Are you 18 years of age or older? YesNo If applicable: Military Service Status ActiveInactive Branch: Can you provide proof you are legally able to work in the United States? * YesNo Do you have reliable means of transportation? * YesNo Do you have a valid driver’s license? YesNo Have you ever been convicted of a felony? (answering yes will not automatically disqualify you) * YesNo If yes, please provide a detailed description: Are you willing to authorize a criminal background check? * YesNo Acknowledgement: I understand and agree that I may be required to undergo and successfully pass a screening for alcohol and/or drugs during the schooling process and if enrolled, as required by the Company. Signature: Read carefully before signing: 1. I understand that the receipt of this application does not imply I will be enrolled. 2. The statements and information furnished by me in this application are true and complete. I understand that I will be subject to immediate dismissal or refusal to enroll if, at any time, discoveries have been made that I have omitted, misstated or falsified information on this application or at any time during the schooling process. 3. I authorize Canine Clippers, Inc./Featherle Pet Care/Wash-N-Wag, to conduct a background inquiry to verify the statements and information on this application, and/or other documentation that I have provided, and other area that may include prior employment, consumer credit, criminal convictions, motor vehicle history and other reports. I authorize all previous employers or other persons who have knowledge of me, or my records, to release such information to Canine Clippers, Inc./Featherle Pet Care/Wash-N-Wag. I hereby release any individual, agency, and Canine Clippers, Inc./Featherle Pet Care/Wash-N-Wag, from all claims or liabilities whatever that may arise from disclosure of such information. 4. I understand that I may be required, depending upon my position, to sign a non-competitive, confidentiality, and/or business ethics agreement as a condition of my enrollment. My signature certifies that I have read and agree with above statements.
